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FOR OFFICE USE: - Permit No. .�D�-��---`-5.- --------------:- ---------------------------------------- APPLICATION FOR SANITATION PERMIT ---------- ------------ .----• Date Issued .-.�.��_- -------------- - (Complete in Duplicate) -- ----- ---------- - :; •. : : e)s, - 23a —O 6 This Permit Ex fres 1 Year From Date Issue ----- ------------------ ----- r }ion is hereby made to the S'an Joaquin Local Health DiNoc for a permit to construct and install the work herein described. p,ppiica This application is made in compliance with County Ordinance LOCATION= JOB ADDRESS A / Phone------------------------�T Owner s Name__ -------- ------------ ----- - ---r - i Address c -p - -------- ------- Phone.. { -------•---------- ---------------•-- Other Contractors Name__ ^ Motel ❑ s, Trailer Court ❑ ❑ - Installation will serve: ResidenceZA�tm-ll House ❑ Commercial ❑ �_ j �__ Number of baths __� Lot size ____ -�----- -- - � I Number of living units: ___�_-- Number of bedrooms -- th to Water Table -------- ft. Y Y ❑,Private [ /Dep a Water Supply: Public:system ❑ Communit s stem Adobe Hardpan ❑ Gravel `Sandy Loam Clay Loam ❑ Clay ❑ ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ 11,*New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ INo ❑ _) :No ❑ Previous Application Made: llf yes,date----------- ---- _ TYPE OF INSTALLATION AND SPECIFICATIONS: r - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t g, 1Weil________________ Distance from foundation _-__-d_._-_____-_.__.Material-------------- ------ �x i Sep❑tic Tank: Distance from nearest de h - ------ ----CaPautY--•------------------- ,.1 No. of compartments..-------- --------------Size � an l Disposal Field: --------- Distance from nearest well--------------- Distance from foundation________-___.__--__.Distance to nearest lot line.-_____.___-__.-'' Width of trench , P ❑ Number of lines----------------- Length of each line ---- 1 - Type,of filter material •----- ------ -------Depth of filter material---------------�----dotal length------------------ ----- ------ a ---- ��1 by r_=Distance from foundation___._-o_.__.__..Disfiance to nearest lot line._.------•- t 3.3 .....De th---aS! ----------------- Seepa a Pit: Distance to nearest well_ -- ------ -- __.Size: Diameter-______ __._ p l Number of pits_-_:_.--�---- ------Lining mafeeial------5. �.. , Distance from nearest well-----------------Distance from foundation--------------------Lining material_ _. .__ - els - Cesspool: ---Liquid Capacity---------------------------g Size: Diameter -------------- Depth----- - = r4 i ❑ =-----�-Distance from nearest building--------------------------- I ----- Priv :, Distance from nearest well - --•----------------------------------- ----------- ❑ � Distance }o nearest lo} line----------:-- ----- .F Remodeling and/or repairing (descrlbe):_.____._ 3' -------------------------------------------------- ---------------------V:e— -------------------------------------------:---------- --------- f I hereby certify that sieve.prepared th}sonapplication the San Joaquin Local kHealth eDistr a#n accordance with San Joaquin County ordinances, State laws, and rule's and regula 4 ---------- -------------- - ----- - (Owner a 1 --- --- - + [Signed}..---- � -------------------------------------------------- --- T -•- - sy= -------•---------- m in relation to wells, buildings, etc., can be placed on reverse side). ------------ (Plot plan, sh ing size of lot, location of syste FOR DEPARTMENT-USE ONLY # ---------------------------------- DATE_ /411 ----------------------•----------- APPLICATION ACCEPTED BY _.,_ 4 ,_ •--- --- ----- ----- I i ------------------ -----' = =�; ---------- ---- DATA - ,� - .�.. REVIEWED BY-------------------------- ----- �,.,,�_•-- R�-^ .' DATE BUILDING PER1v11T 1551�ED --- '� ----------------- n --------i - - -' c�__. :.: Alterations and/or recommendations:-. ' Q/ --- ---- I ------------- �: ,. - = - ---------- ----------------------------------------- = --- _ 3/� ---- --------------------- --,- w .. .:_ FINAL" INSPECTION BY-. -a;- ,.; ` SAN JOAQUIN LOCAL HEALTH DISTRICT I, 124 Sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. 300 West Oak Street Lodi,California Manteca,California Tracy,California Stocklon,California K � E5 4 REVISED 8-59 3M 3-'63 F.P.0 D• r� � r -