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APPLICATION FOR SANITATION PERMIT Permit No. _._1.1.9. .._3 in Duplicate)(Complete p ) Date Issued .._.. .... _�'..••d.---- This Permit Expires 1 Year From D'ate Issued 005- /ft o-r $23 x(6fr �det thxS Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work erein described. , This application is made in compliance with • unty Ordinance No. 549. p // 1�1 ..._.�.... ._..- JOB ADDRESS AN LOCA710N. .!. ... ........ ..1 .............................. - Owners Name-----.. . ...----....._..............-... Phone =�0......`_ Address...... . " ............................ --'....__... ..................._.............. ct! • • ---- Phone y/ Contractor's Name......-------------- -•. Motel ❑ Other Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ , Number of living units: ........ Number of bedrooms ........ Number of bath ...... /� of size . .. Water Supply: Public system ❑ Community system El Private �ep+h to Water Table2.P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay [3 Adobe❑ Hardpan 2f-' Previous Application Made: Yes ❑ No M--New Construction: Yes E] No Ly rHA/VA: Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 41 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ ti k: Distance from nearest well............ Distance from foundation.............._....Material........-_....._- ............. No. of compartments_.. .....:...... +..Size...._... Liquid depth..........................Capacity-.._..---5-- .Disposal,F d: Distance from nearest well.> P.1_:.....Distance from foundati n_._fP---.----.Distance to nearest to+ line............._._ Number of lines_........ ......_.r�. '�Length of each line... s?-1...../------Width of trench.....E_21K..........-.......... Type of filter material....s1.l� Depth of filter material..,.. -...Total length.......... G?_.....--_^-�••-- SeepPit: Distance to nearest well,AretG.�.. --Distance m foundation_..�2.._-.---. t i� to nearestas�--- .•••.... i[7 Number of pits----.............-Lining ma+eriaL.. .p.C�=-.---Ske: Diameter..... .. ......... • pth Cesspool: Distance from nearest well.................Distance from foundation........-------.....Lining material......._..._............--------•els. ❑ .Liquid Capacity..._.................._...9 Size: Diameter.......-'-`-------'----'•...........Depth-'-----'............. Distance from nearest well......._............................___......Distance from nearest building_...._..-_--.------•-_----�-•.•••••• Y' -- ❑ � Distance to nearest lot line._.-•_.'---._...............-._................_........_.......____.... \ ^ ......_......_.............-............,_._............_.........-............ ....._.._..._..._....._...\V! Remodeling and/or repairing (describe):.........................._...._.._.. _.------- mil --------------_................._....... -- ...................................•-- ' 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan laws, and rules and regulations of the San Joaquin Local Health District. Sined •-'--f:- -..$11...' ._.�o.IL:T........................................................................-'----'-------------------.....(Owner and/or Contractor) tle... - ........_... By:.......-...........---��t(...1l�tsg.,ll1.t..................----.....-•---.....__.------•-------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _.._.......-' D,_.........-------.....--'- ....... APPLICATION ACCEPTED BY'-- ...... . tr.!... ------ - ......_............. DATE__---------------- ----------------------------- REVIEWED BY................. ....-----'---.'------------- - DhTE..........._....---------- BUILDING PERMIT ISSUED.----------•...................--................_.- --............. z - - ......_..... Alterations and/or recommendations:-------...................................- ..... - _............_-_....-._.._...._ ...... ...... _.. - ---'--- yi '--'-'"-......__.-•--.....-..._...............-'--'---•---.....................:-.,----_.........-----............. • ............ FINAL INSPECTION BY:.. % ......................... Data.l '_w.......fe.Q .-__......................-----......... SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Streot 014 Norih "C'• Sheet 130 South American Street 300 Wast Oak ireet Manteca, California Tracy, Caiifo eia Stockton, California Lodi, California Sar ES-9-2.v. Revised 8-'59 F.F.Cc.