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FOR OFFICE USE: permit No. ---- APPLICATION FOR SANITATION PERMIT ----------------------------- ---- ---- ----------- (Complete in Duplicate} - Date issued -_--- ----- :-------" This Permit Ex fres 1 Year From ate issued -_.-..-____." herein described. --------------------- r Joaquin Local Health District for a permit to cons#rut+ and -install the work - Application is hereby made to the San with ,_�� ,.�` This application is made in compliance with County Ordinance No. 549. 11 -- -- -. - - --- - l 1h �,� ----- JOB ADDRESS AN LOW__ �'Apartml j ----- ---- Phone '4ee/ -- Owner's Name _ Address------ Cher .. one.--O ❑ Motel- ❑Contractor's Name---- --- Tra+ler Cour#nt,House'❑ Comimerclal ❑Installation will-serve: �R .t ` , ; -------- 'Number of living units: -�--- Number of bedrooms.- p,riva{e Number ��}�h}o"W8}eoTable --.----- ft• l.yardpan ❑ blit'system ❑ Commu1.n,ty system ❑ Clay Adoba 1 Water Supply: Pu y Gravel:❑ Sandy Loam ❑ Clay Loam ❑ y ❑ - No ❑ No.❑ New Cons#ruction: Yes ❑ No ❑ FSA/V A: Yes ❑ Character of soil to a depth of 3 fee#: Sand ❑ Previous Application Made: (if yes,date- _ TYpE OF lNSTALLATION.AND SPECIFICATIONS: '1 -- (No septic tank'or cesspool permitted if public sewer is available within 200 fee{. r I 0 pistan xom f ndatiop-------— --- --Ma er al-:---_= " 1. } Ca acity._ 2 - -- Distance from nearest welly ---- _ �� p. Septic ank: � �L-i uld_dep�h=- ---- ---------- --- -- No. of compartments--�"`�-��--�" -S1z j - a° Distance to nearest lot ln e- ---- i - Dl_pis} ce from, foundation_ -t. Dispos Field: Distance from nearest well.-j".90 .m. % r pe Width of trench.---`- •--: -"- _____ ---Len th of ------_W- �� -- ` Number of lines------ g. __.Total length__."-d'� .f ,J'� pep+h of filter material__.. -��- f Type of filter material-1.�1 ---------- ,, pis+ante to nearest lot line-�---".----- d� ----=Distale f o foundation__--� rr 2�' Seepie Pit- Distance to, arest wel___ -- ----- ;_. ..Size: Qiameter. Depth 141, Number of�pifs--. ---:-------Lining material____ �.. _L-quid Capacity----------------------------gals. Distance from nearest well_________________Distance from foundation.._.---------------fining materia----"---------------- ,-Cesspool: ------- ;,�' Size: Diameter ---�.:;-_`_---- ---- --------'-Depf ------------------------------ ------------------ 4e ---- -- 9------------------------------------------ - -----------------------Distance from nearest building ' I ❑ Distance� nearest well------------- ----- --------- Privy: ❑. Distance to nearest lot line.----.-- ,----- r ----------•-------••-•--------------------------- Rmodelig and/or repairing describe): --- - ------ --------------- ---- -------------------------------------------- em a ---- - - = - __ _-"-------------------- ---•"----""`"-" ---"----- lication and that the work will be done in accordance with San Joaquin County I hereby certifyZlyeared #his appordinances. State la .regulations of a $an Joaquin Local Health District. nd�or Contractor) --------------------------------------- 5i ned .. -------(Title)---------- ---------------- - , --- _0- --- ------------------------------- ,. By: plan, showing size of lot, location of system n relation o wells, buildings, etc., can be place on reverse side). t FOR DEPARTMENT-USE ONLY ) l r ----- DATE-_42-7 APPLICATION ACCEPTED BY_____�' -�`` I -- -- ----•- DATE---------•--------------------------------',-------------- --------------------------,.---- __ --------------------------- REVIEWED _ REVIEWEDBy---------------------------------------------- - --------------------------------- DATE----------------------------------------------------------- -- i, BUILDING PERMIT ISSUED------------------------------------------- .-------":---- ------------- - -------------------- ---------- --- Al#era+ions and/or recommendations: --_- -------"-_......................--------------------------------- ------ --- - -----•--- ------------- ---------------- 1 - _ Date---`- /- .{t_. ------ -- - AL INSPECTION BY SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 2o5 West 9th Street 1401 E.Hasellon Ave. 30o West Oak Street Tracy,California Lodi,California Manteca,California i Stockton,California E5 9 REVI56C B-59 3M 3-'63 F.P.Co. 1 _