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FOR OFFICE USE' ------ -------- -- � " r"" APPLICATION FOR SANITATION PERMIT Permit No. •-------•-----••----- "�I----- ----- - -- (Complete in Duplicaita) Date Issued .----1•~---------1 ---- --"- - - --"------ ----------------- -------- This Permit Ex fires 1 Year From Date Issued ----------------------------------- -------------- Applica#ion is hereby made to the San Joaquin Local Health District for a permit to construct and ins/alft3he w1 2y —rk 0_31described. k This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND C TION ' "` - _.. 211 ---•----•-----•----------• -. ----------- Phone Owner's Name --------- t •------ - _ . ----------- --- -PRone ..----- Address_..-----•------------------- --- ---------•-- ---------- - --- -•--- -------•--- -----�_ Motel ❑ Other ❑-; F Contractor's Name----------------------- __ ; Number of Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ` _ baths Lot size ..�Q f_lX�D__�-----•-----•-----• ---------- rooms -- - Number of living units: .___ Number of bedrooms _�- Depth to Water Table .��f#• Water Supply: Public system Community system ❑ Private ❑ p ardpan Sand Loam ❑ - Clay Loam ❑ Clay ❑ Adobe ❑ } i Character of soil to a depth of 3 feet ,Sand ❑ Gravel ❑ Y FNA/VA: Yes No ❑ Application Made: (!f yes,date--------------------1 No [� New-Constru tion: Yes �No ❑ Previous App• I-, . . �'�-T. / TYPE OF INSTALLATION AND SPECIFICATIONS: ;` -.��_� l �,._. > (No septic tank or cesspool permitted if public sewer is available within 200 feet. � �.. m foundation---`e----------Mate r�l� r__ . I Septic Tank: Distance from nearest well Distance fro rf -Liquid depth------ __ y._._--____..Capacity-- �J 0� No: of -_compar#menu".___.o�---------- i - Width of trench. --�-, Disposal Field: Distance from nearest well_____- ------Distance from foundation__._ --------Distance to nearest lot fine__ _"__.____.__. Number of lines_--� `--r/ ----- Lerig#h of-each rnal....----------;---- 1 Type of filter materia![ X44-Depth of filter mate ---- Total length-___ _ :f�-•-=--•• `"" ' r ._"f' se fJ Size: Diameter---t: --- Depth ------- - Seepage Pit: Distance to neares# well_____ ---- Distance from foundation____----------.Distance to nearest o line of pits------/-------------Liniing mate ria aIs. ' Cesspool: Distance fl-Om nearest well-----------------Dep+hGe from foundation. -- -- __._Liquid Capacity_.-.________.--_--_-----•-9 ❑ Size: Diameter------------- - - � Distance from nearest well_..__-"------------------ ------ -----`--------Distance from nearest build••sng------.--------------------------•--------� Privy: ---------- ------------------------------------ ----- ------------ ❑ Distance to nearest lot line-------------------------- i f --------------"----•------- Remodeling and/or repairing (describe)-------------- lam` ------- ------------------------ re are d s application and that the work------------ - ---------------•-- - ui ----------------------------------------------------- -- - - --------------- -----•-------------------- � ill be done in accordance with San Joaquin County ------------- I hereby certify that I have P p ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. a ---------------'----- ---•---`---- - tor Contractor _r!�-, - -------- ----- - ------ ----- - -- -----------•-----: BY------- ---------si--a--- ze of lot, to anon of syst in relation to wells, buildings, etc., can�be�place _ . on reverse side). (Plot plan, showing-- . :r. FOR DEPARTMENT USE ONLY -- {------ - 1�---------------------------- DATE APPLICATION ACCEPTED BY----------- S �` / REVIEWED BY ---- -- --------- --------------------------------------- DATE------------------••---------------------------------------- ------------------------- - ------ ----------------- ATE �. .;... BUILDING PERMIT ISSUED------ - ----- -- (-_ - -_:--•• - -- Cl Alterations and/or recommend ations:_,! `` - ------------------------- - --- -------------------- -------------- ------------ ' ---==----------------------- Date---------------/-1...... = FINAL INSPECTION B SAN JOAQUIN LOCAL HEALTH DISTRICT 1Z4 Sycamore Street 205 West 9th Street 130 South American street 300 West Oak Street Tracy,California ' � Manteca,California Stockton,California Lodi,California E8.9 RCVIe ED 9.99 p•P.CD.2M 6.60 1•-