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APPLICATION FOR' SANITATION PERMIT Permit No. -----11 (Complete in Duplicate) Date Issued .__ 6/y•-� de to the Sari Joaquin Local Heal District for permit to construct and install the work herein described. Application is hereby'ma a f This application is made in compliance with County Ordinanc 0 No. 549.> D r_L.�.. .r p ------- JOB ADDRESS AND L CATION_-__-- 2:2 on ---- -------•-•. - ---------------_ Owner's Name-------- - ---------- ----•-- -------- -- • r --- ------ , Address--- one. - - -----�-===--�""`---r--- -- Other +i Contractor's Name____ # Motel,0 ❑ { ti Commercial ❑ Trailer Court ❑ Installation will serve: Residence &2Apartment-House ❑ }. Number of baths.-/---- Lot size .... ... ... � Number of living units:- ---.- Number of bedrooms i s �l t ommuriit s 'stem ❑ Private ❑ Dept h, Table Water Supply:-Pub system g� Y Y i, Gravel W Sandy Loam ❑ Clay Loam ❑ Clay, Adobe❑ 'Hardpan Character of soil to a"depth of 3 feet: Sand ❑ ❑' PHP�VA: Yes ❑ No ❑ Application Made: Yes ❑ No ] New Construction: Yes,lNo ❑ Previous App' - .. TYPE OF INSTALLATION AND SPECIFICATIONS:- �, t (No septic tank or`cesspool permitted if public sewe�is available within 200 feet.) ` p - --------- _ MateriaiG-- �• -r•�•-• ' }ante from faundation.__;��------- - . ---- -------- septic Tank: Distance from nearest weil_/6U-Dista Li uid depth_--___ 4 Capacity.___gs�-------- No. of compartments__-------------i Siz _* ?� �.- q . - - " istance from-foundation. - ------Distance to nearest lot line --- s Disposal Field: Distance from nearest well. oZ'�'t-� u� a_� Width of trench_____ '-'G--�-- Number of lines________-f--.-- - Length of each line_______ �r `� e th of filter material____`----- --Total length •�7- i Type filter material -- -.---,�� q� �--:Distance�t nearest lot line__._/ �--- " -D istance f 'foundation'.. ' - 4 1 ------ p Seepage Pit:` Distance to nearesfi well__- tsr Diameter:__��------Depth-._..__. -t�� Number of pits:---- ------------ Lining -Distance from nearest well--------- ------Di'stance from foundation-____._._._._-_:___.Lining matenai-____._-.______----- Cesspool: -Liquid Capacity-- ------------- gals. ❑ Size: Diameter----------------------- -----------------Depth--------=------------------------ --------- Mstance from nearest.well-------------- ------ -------- ------ Distance from nearest building------------------------•---------------- Privy: .,, --"--------=-----------=----------- Distance to'nearest lot line_-------------- ------ ---------- ------------- - - -------------- ------------------------------------------------------ Remodeling and�or<repairing (describe]:------- --`-----' ----- --- } ------ ----------------- ----- - ---------•-----•------: - N --------------------- -------------------------------- ------------------------------------------------------- dp = - ------ ------ - - I hereby certify that I haveprepared this elf the Saand n Jothat aquin hL cal�Heallth District. accordance with San Joaquin County ordinances, Stat s, and rules and regulations (O�rner and/or Contractor) C - :--F rY L (Signed _C6 tl = ------------- I : (r e) - _- - ---------------------------- (Piot plan, s owing size of lot, location of syr#em in relati�on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------ _ . - DATE----- - - APPLICATION ACCEPTED BY DATE---- --------------- REVIEWED BY_ -- --------- = ------------ -------- REVIEWED -- --------•--------------------------------- DATE . �: ----- ------ BUILDING PERMIT ISSUED-------=-- ---- --------------------- --- Alterat' s an /or recom e dam ---------------- g = -------•-----------•----•------• Ya l ---t--------------------------------------- ------ - © -- ----------- ------------- E ---- ---- --------------------j ---- ----'-- ____ Date-_._- - �---�. -="�....-•--- ------- _. FINAL INSPECTION BY:._ -- +- = === I�: ------------- SAN - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 132 Sycamore Street 134 South American•Streef 300 Wes+ Oak Street Manteca, California Tracy, California Stockton, California Lodi, California ES-9-2M Revised 1-57 F.P Cb. i ' —