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O APPLICATION FOR,,,SANITATION PERMIT Permit No. _.j -S---..--- �' r (Complete in Duplicate) Date Issued / This Permit Ex ire's 1 Year From Date Issued 'the San Joaquin Local Healfh District for a permit to construct and install the work herein described. Application is hereby made to 1 This application is made in compliance with County Ordinance No. 549. I wg JOB ADDRESS AND LOCATION ------- -------- ---------- Owners Name-:------ ---------- -------- Phone t -- - ---- --- -------- -------------------------------------------------------- Address _ . o 'Contrac#ar's Name_ -• ---F Pit ne , .. rMotel.. f, `.Installation will serve: Residence'[�Apartment House ❑ Commercial ❑ Trailer Court [I ❑ Other [-I a R' �r 1 ,Number<of baths(::7p---. Lot sjze __ �2___�if /--------------------•-- �,, Number of living units�/-_ Number of bedrooms . � _ Water Supply: Public systefn ❑ Community system E] Private [al�Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑; Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Pr-lTardpan ❑ 1 'Previous Application Made: Yes ❑ No lew Construction: Yes ❑ No Er FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i y " (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tx- 9 - - Material_______.___._____._____ ______________..______ Ta Distance from.nearest well-----.._�r-- Distance from oundation_______________ N _f cm r _ < Size - Liquid depth---------- --- ----------Capacity opartments---------------- f ... t 1 ° al Field: Distance from nearest well---------------__Distance from foundation--_____- -.________.Distance to nearest lot line____:___._,___.__ Number of lines-------- ------------- Length of each line-----------------------------.Width offrench_---------:---.-------------------`---. ------- f ` Type of filter material_____________--___ _Depth of filter material----------------------- length---------------------------------- - Pit: Distance to nearest well� �______._.___Distan� om f undation____td_._-.Distance to nearest-lot line_.os___ Number of i#s-----:= - Linin matecial_� -..size: Diameter--- - ----- ----Depth--- ------------------ 0 Cesspool: I Distance from nearest well-------------------Distance from foundation------ ------------- material--------- -------------------- ❑ ' Size: Diameter----------------"------- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. w Privy: f Distance from nearest well----------_-------_ ------------------------Distance from nearest building_.---------------------------------------- ------------------------------------- ❑ Distance to nearest lot line-----------------------"= = Remodeling and/or repairing (derscribe)------------- ----------------`-------------•-------------------------------------- ------ 6+ I .�.... I ------------------------------------------------------------------------------------------------ •------------------------------------ ------------------------------ -------------------•------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SAfe laws, and r and regulations,of he San,-,Joaquin Local Health District. ' Contract (Owner and/or or) (Signed)------ r�",' ---- -- By:----------------------------- (Title) - --t---- of lot, location of system in relation t ells, buildings, etc., can be placed on reverse side). [Plot plan, showing size FOR DEPARTMENT USE ONLY a - f APPLICATION ACCEPTED.BY------------------------- - ----------------------- e,----------------------- DATE------� �=� REVIEWEDBY------------------- =- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------- ---------- -------------------------------------- DATE------------------------------------------------------------ -- -------------- Alterations and/or recommendations:-----------------------------------------------------•-------------- ------- -------- --------------- •-----------•-------------------------------•----------- -- ----•-------------- >rr�-x ----•- ---- -- --------- - L ------------------ ------------------------• ---------------------------------------------- i __--------------------_-----------------------------_________________ ____________________________________ --------- FINAL INSPECTION $. ---------- ----------- Date-- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS-9-2M . Revised 8-'59 F.P.Co.