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APPLICATION FOR SANITATION PERMIT 4/� Permit No. __l-•-�__�-�--•---- /14 (Complete in Duplicate) Date Issued ----.•------ is hereb made'to the San Joaquin'Locale Health District for a permit to construct-and install the work herein described. Application Y This application..is made.in,compliance with CouMty rdinance No. l ©��- LWO-1tt 7� �7f--- 7� - JOB ADDRESS AND ATION---- Phone------------------------------------ Owner s Name------- ---- ---------------------------------- --- Address------•------ -- - ----- - - -- -------- one----------------------------------- ef Name______________ Motel Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ - y � Lot size _._ _ ��-��f------_____------------ Number of living units: __ -_ Number of bedrooms _J..Number of baths __ ____ g t / "'ft. Water Supply.• Public system ❑ CommunDe ity system ❑ Private pth to Water Table - Adobe ardpan (3Character of soil to a depth of 3 feet: Sand E] Gravel -1 Sandy Loam ❑ Clay Loam ❑ ' Clay E] .11. No Naw Construction: Yes [�No ❑ FHP+/VA: Yes ��o ❑ Previous Application Made: Yes ❑ ( , TYPE OF INSTALLATION AND SPECIFICATIONS: 1 [No septic tank or"cesspool permitted if public sewer is available within 200 feet.) �.. „ . --=-•------- 04 O i Distant f om foundation__l --.=-----Material___ ---- Septic Tank: Distance from nearest w pl_ lf�-.--- Li uid de th_ �- Capacity___ -. � X- q ziO"' No. of compartments--__ --------------- Size_-,, - -_-- --- -- - / .r __ Disposal Fieicl: Distance from nearest well___!_ -.-Distance from foundation-_--��'---'- , Width oftrench es o Er- { . ;�, ' ------Length of each line----7 --� �; Number of lines__-.____ __ - �. 1 De th of filter material----�r�-.------•--Total length-=--- ---- --------•--------------------- � ( +Type.�of filter material___✓ «� -- p l 1� Distance fr m fou n tion____ t' --------Distance to nearest lot line ? --- 4 Seepage it: Distance to nearest well_ - Size: Diameter__ . -------------Depth_--.�-il'---- ----- Number of pits------ _Lining material-Xi'r ' Cesspool: Distance from nearest well___-________'--._Distance from foundation____________________Lining materia _________._--------_-------------- -De th-------------------------------------- ------------Liquid Capacity gals. ❑ Sizer Diameter-------------------------------=-- -- p Distance from nearest vrell--------------'---------------;----e., Distance from nearest building - Privy: ._ .�- .:k ,✓ � � ❑ Distance to nearest lot --- ----------------------- j ------ ( � Remodeling and/or -repaEring (describe):__,---- --:- -- ________________________ ___ t - - ------------------------•---•- ---------- ------- - ---------- ---------------------- -- - - -------.---- -- -----" -----------•--------I- --------------- n -hat t I hereby certify that I ha' pr dareduthis lations Ili the San Joaquin�Loc al Hee worli al#heDgs}�:I�{n accordance with San Joaquin oun y s ordinances, State laws, 'and r les g ------------------- �or C on ract # (Signed)-------------------- - , ---�--� ---- t �r .�L.�---------- ' J / (Titles---- k By: - g p Plot plan, showing size�of lot, locatt of system to relation to wells, buildings, etc., can be laced on reverse el. ' { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------y --------- '�... "` DATE _=_ --------•------ -------------- - �.:, �� DATE__�--- ------------------------------------------ REVIEWED 13Y �' =- --------------------- --, BUILDING PERMIT ISSUED--------- --•----------- -------------'--------- -. ----- DATE - - - - -- - ------- •---------------- .: --------,--•---- ---••-=--- =, = a Alterations and/oar t;ecammend ti ns: ✓lr :r �. - --------------•---------•---------•--- p __�_ q -------------------------------------- ; -- -- d ----=-----_--- ----- ------------------- - - ------------ Date---- 11171 --- ------ ---=-- FINAL INSPECTION BY----------------- --- --- ---------------------=--- f l SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street +.4r j f. . 7-132 Sycamore Street' 814 North "C" S#reet 130 South American-Street Manteca, California Y Tracy, California Stockton, California Lodi, California ES-4-2M Revised 1-57 F.P.CO.