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FOR OFFI USE- 4F. -'j l d ,` S_d'-:3 Permit No. __. _.... �' --- ----- '� ^� APPLICATION FOR SANITATION PERMIT - --- - --==�- ----- ------ ----------- ----- (Complete in Duplicate) Date issued ---• -- 6 ----------------------- This Permit Ex fires l Year From Date Issue Application is hereby made to the San Joaquin Local 1-lana}�h piNo�549.a�yp�rmit to constrLct and install the work herein descrl . Pp � �i a This application is made in compliance with County Ord JOB ADDRESS AN LOCATION__ ------------------ 1 l ------------ Owner s Name.. --• -• ••- - � -•••- G+�,�-------- .fir _ t Address .I ........................ Phone - - i O he ' " •-------------------------------- Motel,❑ � fi r A• Contractor's Narne__ •- -••---•-•................ .••-_-- •------- - •-- - Installation will serve: Residence, House ❑ Commercial ❑ 'Trailer Court ❑ ` Il Lot size ..��-�:•'�------------•- Number of living units: .----"-•Number of be _ --- Number of baths 0Wa ` Private ❑ Depth To Water Table ,� f#• `s. }. Water Supply: Public system �ommunity system ❑ '' Clay'❑ Adobe�ardpan ❑ ` Character of soil to a depth of 3 feet: (Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ �,� p No New Construction: Yes �No ❑ FHA/VA: Yes i7 No ❑ Application Made: (If yes,date "__.- ---- - ) Previous App' tithin-100 TYPE OF INSTALLATION AND SPECIFICATIONS:(No septic tank or cesspool permitted if public sewer is available wfeet.) t- r Distance from nearest well__�*A6-€Distance from foundation___- __-____.--.Maters-- ------•-Capacity..-ld a Septic Tank: - SizegG` Y4 -Liquid depth__ I No. of compartments_:____- �'--nearest line.Length ------ ' i . Number of lines_.___' .----- g .. Total len th_../a�----•------------ _. .� Type of-filter material._._ ----•Depth'of filten�matenalj-_ _.Sl'---;�•----- C " ____Distant rom founds#ion__.�d.-----•-•-� • tarrce #o nearest lot line--!r-••----�•- Seepage Pit: Distance to nearest well_--------- - �� ----.Size: Diameter___%1&__.i_.-----Dep#his.!.._.__..____•---•---• o9------------Lining materia._. �. ------ L1 Number of pits"- Distance from nearest well----------------•Distance fromJEfound I I-:�--------•------LiningqCapacity --- -------gals. l Cesspool: L'q p ty----•--•----------•-----•-•- ----•.De Depth ---•-----=----- --- m Size: Diameter---------------- p i ❑ ------------=--•--------- ___--Distance from nearest building----------•------- Distance from nearas# well____..________- ------------- --------- Distance '- ". '� •---...---••------•-------•-•---•---•---•--•---• ❑ Distance to nearest lot line----------------------- 1 _ - descrl 'e) Remodeling and/or repairing f .tom, E . , ------- ------- --- l licati and that the work will be done in accordance with San Joaquin County I hereby certif that I have' ar d't ' app ordinances, tate laws, and rules egu tions of t San Joaquini�Lacal Health District, -------�------- ------ ------ -----•-----• ..............-.______(Owner and/or Contractor] 51 ned -- ----- -- ------------ `_...._ ------. (Signed) 1 (rt e). By:------------------------------------- •- ••------- ---- . (Plot plan, showing size of lot, 10 tion of system/in relation to wells, buildings, etc., can be placed on reverse si e ii FOR DEPARTMENT USE ONLY r / ---- ' DATE.---- = / 1. APPLICATION ACCEPTED - -" DATE _.R__________ __ _"_____-______ __. REVIEWED BY------------------------- --- ------------------- --- ------ --- DATE----------------------------------------------•-------------- BUILDING -- BUILDING P€RMIT ISSUED-------------------•----- - ----------- Alterations and/or recommendations:______.._ .-_.__.. --- ft 1 -. �.ty. ---------- + . --------••-•---•--------- _ ----------------------------- .- - ------ P�r: �f� ' �- - .................... - ;- .l - .. r . ........................... .......... i Date---------- -- `S._"._4�- C a- ------•---------- FINAL INSPECTION SY:.._...........:... w SAN JOAQUIN LOCAL1HEALTH DISTRICT I ,y�. 124 sycamore Street 205 West 91h Stmt 300 West Oak Street Tracy,California 120 South American StreN Manteca,California Lodi,California Stockton,California i ' I E8 9 REVISED 8-59 2M 5-62 ATLAS it