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FOR OFFICE USE: ----=-------------- ---- ----- ------------------------- APPLICATION 'FOR SANITATION PERMIT Permit No. _ (Complete in Duplicate) ? Date Issued -----_----f "" " This Permit Ex ires 1 Year From Date Issued -- -- - - -. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. `J1�' � This application is made in compliance with County Ordinance No. 542. 6-R -----------,- --,;----•------•-•---._....---- JOB ADDRESS AND LOCA ON.._____ __ _ ---- ..'_i Owner s Name---- o :, ------ Address---------------- ---- = --- - one -----------------•-- --------- - ----- --- .--,_.--�-------- ------------------------- + E] �" Other Contractors Name------ hailer Court 0 Motel ❑ ❑ � Installation will serve: Residence iApartment House Commercial baths i� _ Lot size _ - "-s --`---- Number of living units: _�- Number of bedrooms _ "_ Number of r ° ` Commuriit s stem �t Private ❑ ,Depth to Water Tabled ft. Water Supply: Public system ❑ l # y y il: r Adobe Hardpan ❑ Character of soil to a depth of 3 fee+: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ A ion: Yes ❑ No FHA/VA: Yes ❑ No ❑ Previous Application Made: (if yes,date----------- No ❑ New Construct TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k d mon----------------- .Material a ank: D�isstaonf compartmentsneare }_wel------------------- Distance� from foundation depth------------------------ Capacity-------------------� f„ ......rte, ,+ Disposal field: Distance from.nearest well Distance from',foundation �".---__----Distance to nearest lot line_��_ Len th of each line_,�Q� �dQ- yidth of trench------- -- ------------ �- }J _j� p r /1,11------Total length-------------------- � Number of lines___ ___ F''"' 9 Type of filter,,mater.iaL_J_._ _ -" """--• -" - E__"- ._...Distance to nearest lot line---------------"- J r Depth of filter materia� n ---- ---------- Seepage Pit: Distance to!neares#.well_" Lining --Da#trace from.foundSze: Diameter.________________. --Depth----- ❑ Number of its__- g 1 on. --' ----------.Lining material-------------------------------- ---. Cesspool: Distance from nearest111 ____----- ---Distance fr foundatil�""" : -----------Liquid Capacity_.._-----------------------gals. O ❑ Size: Diameter --.. ----------------- . p , l Distance from ne- ... :weiI' _, �__.--.-Distance from nearest building_ _____________ _______ ___ __ ---. Privy: ------- -- -- --- ,--------------------------------------- Distance to nearest lot line-------------------------------- Y ------------ -------- ---------- -- L , ; Remodeling and/or repairing (desc'ri4�e):- -�, -----t - "_k_____ -------- `- ----- ----- I her - certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r aws, an rul ordinances/, St to le nd regulations of the San Joaquin Local Health District. h `�" t Owner and/or Contractor) ed -- --- ------ - -- --- (Sign �•-- • --- ----'--------- -- --i ----- -- - ---�-Jr tion to wells, buildings,�------ --�--)Tile)------ - - - --'-------- --------- ---- - - ---------------- by:------------•-------- •--- - ----- -------------------- --- - -- --• (Plot plan, showing size of lot, location of system in � � etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.------------------------ - -------------- --------- ----------- --------- - -----f---- •--- DATE------ / � � DATE--- --------'+-- -•-------------------------------------- REVIEWED ----- - --------------------------. REV1WEQ BY_ ---------- ----------------------- - ---�--- ---------- ----- I 1 .. 11 ------------ DATE--------------------- -----------'.�-- --------------- -- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- - Alterations and/or recommendations------------------- --- - - - �" " " r -d - ------•------- iG�z1' -•.,a..nr,ry z -tea � .f '<.�------------- ----------- :•--- - . 17r T -------- - - - i2. _- --- - =a-. "----•--------------- ---- � --------------- ------------------ ---- --------- ----------------- ------- -----lam=--"---------- -- -- -- FINAL INSPECTION BY-------------- -------- ------------------------ ---------------- /0 ------------ Date---------------------------- --- ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California Manteca,California Tracy,California Stockton,California ES 9 REVISED 8-59 3M 3-'63 F. -rd —