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APPLICATION FOR SANITATION PERMIT PermitNo.No. S -��'�• 4 (Complete in Duplicate) Date Issued ._3f-�ly made to the San Joaquin Local Health District for a permit to construct and install the work herein described. { Application is hereby ! This application is made..in compliance with County Ordinance No. 549. , M i. -----------------------•---• ------------------- J V/ == °------- JOB ADDRESS AND L CAT N__. one ----------------------------- OwnersName------ / ---------------------------------------------•----- ..----- �P W Address Phone. - --------------------- Contractor's ame---------- --- Motel ❑ Other Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Number of living units: _�.-:- Nu ._ Number of baths - . Lot size ._ ------ mber of bedrooms _ / Cl th Water Table _ 7t. Wafer. Supply: Public.systerrm"�Community system ❑ Private ❑ Depth-to _ _ a Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ : Gravel El Sandy Loam El Clay Loam ❑ y ❑ Previous Application Made: Yes ❑ No J�r New Construction: Yes El No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permittedif public sewer is available within 200 feet.] } Sep Tank: Distance from nearest well------------- --Distance from .foundation-------------------Material__--------------p- Y-------:------^----- x No. of compartments Size_---:--•-------•------------ ---Liquid depth Capacity Disp a Field: . Distance from nearest well .------------_ DLenath of nce reach line--------------------- om ation_______ ___________W dthcof}trenchest lot-line------- -------- Number of lines__-----•-------"-- g _Total len th------------------------------------ -Type of filter' material---------------- -------Depth of filtermatenaL-,-------------- g1 _ . Distance to nearest well_ Distance fro fa dation__ -'-- Distance to nearest lot line___--------- Seepag Pit: j - De th---- %:$ ---•-----••. -Linin material/� __.._Size: Diameter_ Number of pits.---/-------------- -" _ Distance from nearest well ____ _g____Distance from foundation--_.-.___--_____--.Lining material---------------------------- els. Cesspool: _-Li Liquid Capacity ----- -----g } ❑ Size: Diameter------ -------=------v--- -----------Depth_:._-- ` ` q p y . r' T3 —b � �� : - Distance from nearest building Privy: Distance ',ro'm nearest ural ._::--- ------ ❑ - �•� �- Qistance to nearest lot me_______.-_ --------- ----------- ' ----•----------__--------•-- ---------•------- --- and/or repairing {describe}_ ________________ __--------- Remodeling ---•---------------------------------------------------- :._;,, „a l I hereby certify-that I have prepared this application and that the work will be done in accordance with San-Joaquin County C ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 0. ih � �'"a�e ontra or -------------------------- s Si sed _ ----- -- --------- -- ---------------------- - - ------- ---- - ( 9 ) -------- (Tit e] By:--_------------- gp k (Plot plan, showing size of lot. I tion of system in.relation +o wells, buildings, a+c., can ' e ace on reverse e . FOR DEPARTMENT USE ONLY DATE-------ter------------------------------------------------ APPLICATION r-------------------•---------------------------APPLICATION ACCEPTED"BY-------------------------- DATE______._.-__'_- -- - ----------------------- DATE------------•----` Q ---------- ----=---••----- -- ---------------------------------------------------------- REVIEWED13Y--- -------`----------------------- -=----�-------" ---- -- 4 BUILDING PERMIT ISSUED------------------------------- �_-• I - ---'�--- dations: - ---•-•-- ----- - - --------------------------•-------•----------------- ------ - -- --------• Alterations--a--n--d------r- n r recons ---- -- ----,�i--�--- ---------------- ----------- --------------- .1 ------------ FINAL INSPECTION• BY::- --- SAN'JOAQUIN'LOCAL HEALTH.DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California ES-4-2M Revisaa 1,57 FY-CO.