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Permit No. .-g APPLICATION FOR SANITATION PERMIT (Complete in Duplicated Date Issued f j Application is hereby made to the San Joaquin Local Health Districtce o. for a permit to construct and in 1 the work herein described. ,is application is made in compliance with County Ord ------- --------------- C JOB ADDRESS AND LO A. TION------ ---------- hone_ - G�:� - --- - - ----- Owner's Nam --------- -• ----------' Address.._ - . ----- -------- ` ' -- Phone _.•_ Contractor's Name--.--___---- Motel Other ❑ Installation will serve: Residence Apartme House ❑ Commercial ❑ railer Court ❑ `� - Number of baths ._/____ Lot size _y� � Number of living units. __-� Number of bedrooms Private Depth to Water Table ft. Water Supply: -Public system Community system ❑ ❑ Adobe Hardpan❑ Clay Loam ❑ Clay ❑ p. Character of soil to a depth o�3�f, et: Sand ❑ Gravel ❑ Sandy Loam ❑ Y t Previous Application Made: Yes F] No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .Material-------- Se ' Tank- Distance from nearest well-----------------Distance from foundation---------------.- 1 -----Liquid depth------------- ------- --Capacity------------------ --- ments---._ -_-."-------------.Size----- -----------•-- No. of compart Dis al Field: Distance from nearest wel4------------- -Dis anh offrom each 4 ne ation---- Width Distancofttrenchest lot line__-_------__---•- C� � Number o�i lines---------------- --------- g Type of filter material-------------------------Depth of filter material----._-----------------Total length_._..-rest.------- 7 _.Distance to nearest lot li --- -------• Distance from f�Lndation �---- 5eepa ePit: Distance to nearest well. De fh--_ - --".---------- " Number of pits-_".---I--------------Lining material,,t --I,_--.-size: Zameter_. p ` - -Distance from foundation--------------------Lining t sspoal. Di tante from nearest w _------------- -- -- --- ----- . 4 r Liquid Capacity -___-. _- -----gals. Depth_ -------- Size: Diameter❑ -Distance from nearest building---------------------------------------- 1 Privy: Distance from nearest well------------------------ --------------- ------------------ ❑ Distance to nearest lot line-------------------------------------------------- - }: v �, ----------------------------------------- --------- --- Remodeling d/or repairing (describe ---- ----------- ------•--------- - •------- ---•-------- ---- -- ,r '-- --- - --------- I h eby certify that`�have prepared t is application and t at the work will be done in accordance with San Joaquin ounty. ordinances, State aws, and rules and eg a+'ons of thf an J . q uin Local Health District., -----(Owner and r Contractor] (Signil '- e (Title)--- �- — r-- ---------------- ---------------- -------- i (Plot plan, sho in s�za of to , oca+,on- f system in relation to wells, buildings, etc., can be p aced on reverse side !. FOR DEPARTMENT USE ONLY DATE--------------- `t - ----------------------- REVIEWED y APPLICATION ACCEPTED BY--- --------------- ,,,�----- ------ ------ ---------------------------- ---- DATE------ --•---- -•-(=�3------------------------------------- BUILDING ----- - ---- REVIEWED BY---- ------------------------------------- --------------- ------------------------------- ------- ---------------- ------ DATE----------- -`------------------------- ------------------ BUILDING PERMIT ISSUED------------------------- -- -------- --- ------------------••-- - -" --.---------------•-------------------------------•------------- Alterations and/or recommendations:_-._----".............._ r G t ___V w�- --------- 77 4 i P- �r r-- --- ---------`�---rl:�.�-----�-,�1� --se�GTz.G_..T�f1�✓.:�---�"---�1��-----_�fi��_��----fir✓,�_-----ice/ ---�----- -�-- A Al 7s s,��D ,rfi / 7V Ta rJ D s 7 . Date---- --- --- ---•--- --- --------- ------•:-- ---•---- tU t $ nn 'FINAL INSPECTION BY: '4- - ' G� cwt. SAN JOAQUIN LOCAL HEALTH DISTRICT.�� 132 Sycamore Street 814 rth "C"iStree# st Oak Street / Stockton, California � 130 South American Street 300 WeTracy, California //1 Lodi, California Manteca, California re—o-91.A io-s2 Revised W-2100 __ s/I/, q