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Permit No. _._�" ..�=-�•- APPLICATION FOR SANITATION PERMIT _E (., (Complete in Duplicate) Date Issued ----------------------- p,pplica+ion is hereby made to the San Joaquin Lo d8natnceDlNoC 549r a permit to construct and install the work herein described. This application is made in compliance with Con y JOB ADDRESS AND LO AT1 N_._.L�- `- -------�-�- ----------------------------------------------------------- JOB --•-------------------------------- 40-./V Phone------------------------ Owner's Name f 1 G ------ L P�-1r'C�� Address------------------••------ -�---- ------------------------------------ honeGe.f. 1--' -------------------- - - Motel Other ❑ Contractor's Name_.__"___._ _-- t s� ' Installation will serve: Residence�' Apartment f"iouse ❑ Commercial ❑ Trailer Court ❑ ja- Number of living units: _`_____ Number of be 2j--- Number of baths j---- Lot size _" - I Publics stem 0 Community system El [] Depth to Water Table -------- f+• Water Supply:Y' Y Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 5� Gravel Sandy Loam ❑ Y Character of soil to a depth of 3 feet: Sand ❑ ❑ El New Construction: Yes No ❑ Previous Application Made: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -------.Mat real-_ �. �-- z I� _a__c,"__._ Septi Tank: Distance from nearest welL�_�------Dista ce from foundatin- depth_____-�----------> -.Capacity__ � t No. of compartments----�e+rr------------ ---Size__-- ��f--- Liquid foundn ---J-6/------.Distance to nearest lot line_".-�___".___. Disposal Field: Distance from nearest well--_. - -_-Di tank of each line a{Iola-�- Width of trench_.-c - ------------ (' Number of lines �r �! ' Type of filter material-___'C��Y--`�- hof filter material-----J-_�------------ otal length_-__ „. Seepage Pit: Distance to nearest well Linin material Distance from foundaZenD1ameter-_--Distance to nearest lot ine__---;_-__:---•- ❑ Number of pits------------------- 9 Lining mat Distance from nearest well_______________-Distance from foundation-__----- Liquid Capacity-----------------------__-__gals. Cesspool: --.---- ❑ Size: Diameter---------------------- Depth Privy: Distance from nearest well--------=-------------- Distance from nearest building------------------------------------------- Privy: -------•----------- -- ---- ---- ❑ Distance to nearest of ine.--"-------------------------•----------- --------------------- Re eling an ^r repairing escril�e):_/".[.� -C.�LJ- _-- --------------------- - ---------------- - -------------------------•---------- ---- ------------------------------------------------ ----•----------------- --------------------------------•------•------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with Sari'Joaquin noun y ordinances, State laws, d rules and regulations of the San Joaquin Local Health District. s' . -.--___--_(Owner and/or Contractor) ~ V (Signed) . . ------ .= Tale (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE.----e---------------------------------------------- APPLICATION ACCEPTED BY --- ------ ------ DATE__.."" REVIEWED BY----- ------------------------------ ------ ------ ---- ---- --- - -- ------ ----------------- DATE---------------- ------� :-- -- ---------------------- •---------- - BUILDING PERMIT ISSUED.-------------------------------- •--- -------- Alterations and/or r�e�commer ations: -. r� 1� r . ---- .. .----- ---- - y. - -------------- p s' ---------C ---------------- - ---------------�-'-0--:-S-7----------.rte= ------ Arm r r z------ --. . ....... ------------- Date---------- ---- ----------------------- ° - -- FINAL INSPECTION BY-------------------------•------ - - --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street ;OD West Oak Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California E�-S 145446�ATWC]flD -