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FOR OFFICE'USE: Permit No. _1 �� -17 �� ,� APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date issued . ----- l - --------------------------------------------------- -•---- -- -------------------- ------------ -"1' This Permit Ex Tres 1 Year From Date Issued permit to construct and install the work herein described. ppplica#ion is hereby made io the San Joaquin Local Health District for a p<<y �" Fl This application is made in compliance with County Ordinance N l ----------------- ----•----------------- aD - - "TION_-. =: ---- Phone� ' JOB ADDRESS AND OC ---- ------ --,-._.- ia --- ------ -- - - C Owner s Name----------- " " 311 p y I ---------------------- Address-------- ------------ __3-------- Phone % +/ it -- ------------- ------------------------------------------------ 1-4LLJJ --- _----..----- --- Motel ❑ O#her ' Contractors Name-------------- --------- Trailer, o } [] i Aar+meet House ❑ Commerual ❑ 1 � - installation will serve: Residence ❑ P , r- 4�r of baths Lot size Number,of living units: __--__.- Number of bedrooms __-----_ Numb. Depth to Water Table y0- ft. �I Private 0 DeP Hardpan ❑ Water Supply-- Public system �' Community system ❑ i. Adobe pP Y• �? _Gravel Sandy'Loam ❑ Clay Loam ❑ Clay ❑ No ❑ Character of soil to a depth of 3 feet: -Sand ❑ ❑ New Construction: YesA No ❑ FHA/VA: Yes ❑ s ;. n f t Previous Applicafiion Made: l4f yes,date-.-- E : ° TYPE OF INSTALLATION4�- AND. SPECIFICATIONS: = tank or cess o01.permitted if public sewer is available within 200 feet•) [No septic to P A .. . Mm foundatic,l------------Matefiaf_ _--- ------ � f, Distance fr „ .--_-Ca pa (� Distance from.nearest well).-e '- ----Liquid a , No. 11 I compartments-------A----- t Distance to nearest lot line. �----- p _ g ach�l#e- 1�'� „Y-Width of trench....- �� < Dis osal Field: Distabnce ofrorf lines 11 earest well Distance of foin anon._ -.� Num Depth of filter material------ - ------- otal length------------•--- - ; Type of filter material_::of vd c P i fM --•-.--Distanr�e to nearest lot line----- ---�- Distance�5.b om foundation '� Depth---------; -�--------- Seepage Pit: Distance to nearest well- -Size: Diameter___ Number of pits-----/-------------Lining material- - material-- ---------------------_--- t , Cesspool: Distance from nearest well--__- ___---[Distance from foundation-------------------Liquid Capacity-.-.-----------------------gals p ❑ Sizer Diameter------------- - Distance from nearest building-- Pr Distance from nearest well------- ------------ ----------------- ------ Dist ------------------------ , ❑ Distance:to nearest lot line--------------------- ------- ------ vR Remodeling and/or reel firing (describe)---------------- --- IIS-----------•-- ----- ------ ------ ------------ ---- ------ ----------------•- ------------ ----- ----- ------ ----------------•---------------------------- ------------------ -------- ----------------------------------------------------- ---------- ----- --------------------- v-- prepared this a lication and -- - --- e -- - I hereby certify that I ha p p PP that work will be done in accordance with San Joaquin County ordinances, State laws,''and rules and regulations of the San Joaquin Local Health District. --- ----- ---------------------------------- -----(Owner and/or Contractor) Si ned --- ----- - ` -- ( , l g } - ---- �i►L . f n .t--e-- - ��--------------------------- - ---Title -. -- - ---- ` T BY:--------------- -- -= y FIs, buildings, etc., can be placed reverse side}. (Piot plan, showing size' of 1ofi, location of s stem to relation to wet ii FOR DEPARTMENT USE ONLY - ---------- APPLICATION ACCEPTED BY-------- ----------------- DATE-------------- --------- M-------- ----- DATE REVIEWED BY------------------------- ---------------- - M - - - E BUILDING PERMIT ISSUED------------------------ ---- / Alterations and/or recommendations:_--_.. 11 --- ------- ---------------------------------------------- ------------------------------------------------•---------------------- - ------ - -=---------------------------------- --------------------- •. -------------------------- - - ll. -- ...I i ------------------------------------------- I FINAL INSPECTION •' - -------------------------- Date------------- - SAN JOAQUIN LOCf AL HEALTH DISTRICT 124 sycamore Street 205 West 9Th Street 16o1 E.Hazelton Ave. 300 West Oak Street CaBfornia ., Manteca,California Tracy' Lodi,California Stockton,California - !! F.F.r A. ! I i�