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I •L-64' . i f Permit Na. .....l--•.- WA APPLICATION FOR SANITATION PERMIT 7 (Complefe in DuplicaFe) Date lssued ._ /'S►,3 r Application is hereby made to the San Joaquin Local Health District•for S permit to cons a insta{l the work herein described.V This application is made in compliance wt oun Ordinan No. 54 Tl N...'� i l JOB ADDRESS AND�LOCA .._._. .. .._.....? ne ho .......... _._.-------------- Ownees Name---f r'� ........... _ Y Address _........._ _ » » �Fhone.. - - --- .. # -a(� Contractors Nenre__-- --- - •l ' " Motel Qther Installation,will serve: •-Residence 0 A�rtment House �] Commercial fl Trailer Court ❑ /� � _ w Number of living units: - N umber of•bedrooms ._.__. Number of the L � sire ~'� ' •� Private �pth to W or Tablef �ft. Water Supply: Public sysW'* Community syste ❑ rn a Loam[] Clay❑ Adobe Hardpan[] Character of soil to a dapth`of 3 feet: Sand Gravel ❑ 'Sandy Loa y ` I'revians.Application Made: Yes ❑44'l�o New Construction: Yes Na ❑ ; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or oesapool permitted if;public sewer,is available within 200 feet.) --•---Material-----__--------•-••----••............ Septic Ta k:r Distance from nearest well_..._-._......_Distance from foundation.— .__.__.. ------' No. of compartments_....w.--_ 3 Size__-----_-..__ --. -- Liquid +ks..........................Capacity... 0 /� Distance to nearest tine__I ..__. Disposal Distance from nearest well. 4l_` Distance from foundation._ WFdtlr of trench•- �•' '' t Number of line,54.A - Length of,each line. -•-•:,. .�� rDe th of filter niefierial... '_ .........Total length Type of filter material_..-__. pl �.�.. _ f Seepage Pit: Distance to neare well. .t ....:_._Distance f m fo dation. _............Diitare toD Depth Eot line.. r a � — Number of pits-_ ...----Lining material. ..Size: biameter-_•__-_d_---__...... Cesspool: Distance from nearest wall--•-•----_••_. Distance from foundation_......'......... ...L-i ring material ............ .... --------- ❑ Size: D'iamefier..... DSP _:_. __ _. :> `; Capacity- - "y+-.._.. ... • - :•- ' Distance from nearest well..................... Dis}once.from nearest buildin Privy: _»..,-- ................. . Distance to nearest lot-lina...................... •-•• r Remodeling and/or repairing idescribe1%. ------ --------------- E ._._.. -------- , -- --–•----- ...............–..........d._........ nty 1"hareby certify 4het I have prepare tl#is application and that the mark will be done In accords with San Joaquin u- ordinances, State laws,an rules and la ' of S n Joe uin l alth Distri _• �_ � ��' �.�... ••-•- _ -• and/or ntrattorJ -. ............ {Signa .. _!-..: •- --- ............... - y-.�. aced on reverse side (Plat plan.aho+Ning size of tat.location of system in relation to wells, buildings, a#a., can be p �- - I FOR DEPARTMENT USE ONLY l r HATE - - / .............ti k 1 i APPLICATION ACCEPTED BY___-..... ....--•..............---••••. r s° ------•---•-------•----•-•-------------•- ----...,._.-- ........-- DATE_............................................•--•-------•-• REVIEWED BY-----. DATE - BUILDINGPERMIT ISSUE•D-----_••-------------—........... ....... ..........••••-- . ..... ..._..__....._».---.._..._ i Alterations and/or recon+mendations.:------------•- -__...-------------------------------------------.......... • ........ ._• ...................... f ....................--........................_......_-_._.1...- ..._..._..__....._.._...................... •___....._"__._.....__..... _.-.................. ..r -4•,I r .-..... `...........................•" .»....-.-..._.-.-- ..._-......... .--_•-••_•------_--------_---- ----`_- _---_ - _._-.....�.---•--........ .................. ' .................. ----•-••--• �- ........................... -- Date..-.._.-.t --�--.�1. ..�_-.....`� ................................... FINAL INSPECTION BY-, .-_- •.. ...... ,SAN JOAQUIN LOCAL HEALTH DISTRICT l I0 West pallkee St 132 Sycamore Street 8F4 North"C"Sfreat 130 South American Stnat Manteca.Caritowla Tmey, Califomis Stockton, California Lada, Califoi%ie / 4 .r • E —9-2M 10-52 Rav:sad W.2100