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rur�urrit-t: ubt: ----------- -I------------------------------ -- ------------------------------------ APPLICATION. FOR SANITATION PERMIT Permit No. 2-�.F. ------------------------------------ ------------------- (Complete in Duplicafe) ------------ ----------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is"e,ely made to the Ian Joaquin local Health District for a Permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND ? OCATION-------- --1 e -------- , -0�----- -- ---- ------ Owner's Name- 12-,--,yy-A -------------------------- ------------ Address- Phone--- ---------------------------------------------------- Contractor's Name ------- ------- Rhone--�-�, Installation will serve: Residence Ap;5rfirrient Hod-se,E] Commerciaj tl Trailer Court E]. Pt El Other Motel Number of bedrooms mb4r of bath L-&flgi7l; Number of living units: -------- N oms S community system 0 Rriv Water Supply: Public system to Water Table ---f----- ft. Depth Character of soil to a depth of 3 feet: •Sand 0 Gravel E] Sang -am Clay Loam [] Clay [] Adobe Hardpan C] Previous Application Made: y '(If'- --- ------- es,date-,—- -- --) No El onstrucfion..' y6s(E] [:1 :,,,FHA/VA: Yes D No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if p'bli 'er-itavailable ;w Septic Tank: Distance from nearest weli- 4�in 200 fee+'.) welt___.__<___-_.____Distance fror� foundation__.- _5 4/1 I ..................................... 0120- lsce No. of compartments--------- - ----- ----Size----- Q I Liquid dep�h-,,---- Capacity--&4v Disposal Field: Distance from nearest well.-_.__`______...__Distance from toiundation----2�al------Distance to nearest lot line--5! .!�tif>Pileme4-Number of lines,------------/----- - each line _J9 ------ ---------Length ea - -----.Width of french---------- ; �V----------------- -11�EX t',S+- Type of filter maierial----.,--Z-�t2O&,4,--Depth of filter material---/X-1--------Total length ,--------------------------i v"'- --- Total Seepage Pit: Distance fon6arest!well-----------I----------- undatior1---,-�9--/--.- Distance to nearest lot line---- D9 Number of pits ------------- �-------------Lining material-_ :3// "-- i Diameter---- Depth------- ................ Cesspool: D.i0ance from nearest well________________Distance from foundation--------------------Lining material.._-_-.._"___.__"-_._____________.__ ❑ Size .Diameter ---------------------- ---------Depth...... -----------------$'-----------------------------Liquid Capacity --- ----- gals. --P Privy: bli%rj�ce;.from nearest weil -------- --------------------- Distance from nearest 60cling---------- - El Distance' fo nearA.f lot line.- ------------------ ------------- ---------- ----------------------E-------------------- ---------------------and/or ejD7a-irinq-(-d ---------------------------------- Remodel'n44 7- , --------- e5CTii7�,K _; ----------------------- --- ----------------------------- ------------------------------------- ------------- ------------ - -----------------------------------------------------__---------- ----------------- ----------------------- -------------------------.........------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County, ordinances, State laws, and rules and regulations of the San Joaquin.Local Health District. a -------------------------------------------------------(,owner ndlor Contractor) (Signed)------ y ------ ------------- - - ----- (Plot plan -----------------------------------------ffitle)�-------- ----- ----- B :- e--M... .... ...... f yst in relation to w. showing lo ells-i-buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- �7 ----------------------------------- REVIEWED BY ---------------- DATE---------- ------- ----------------------------- ------------------------------------------------- DATE---- -- ---------------- BUILDING PERMIT ISSUED--------------------- ---------------- ------- -------------------------------------.-- DATE----------- - Alterationsrecommendations:_____...__-__..... ___ --------- and/or - ------------------------------------------------------ -------------------------------------------------------------------------------- ----- -------------------------------------------------------------------------------------------------- ------------- ----------------------------------- I "---------- -------- ------------ --------------I......I------I- ------------I-------- I----- ---------------------------------- ---------------- ------------------------------------------------------------ ------------- --------------- -------- ------------------------------------------- --------- I ---------------I- ------------- ------------------I---------------- ------ ------------------------- ------ ----------e---------------------------------------- ---------------- -------------- ------ ------ - - ------------ -------------------------------------- ------------------------------------------.------------------ FINAL INSPECTION - -------------- -- ---------------------- Date- -,--------- - - ----- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California P.P.r-o.