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FOR OFFIC SE� > r y�"3 --� Permit No. ---l�-•-•-....._ ` ;r3 APPLICATION FOR SANITATION PERMIT i ------ g3..--1f' - (Complete in Duplicate) Date issued ...1-�- -•••� --------------- ---------- -------------------- This Permit Expires 1 Year From Date issued A plication is hereby made to the San(Joaquin Local Health Diance strict for o a permit to construct and install the work herein described. This application is made in complianc�e/'with County f uT- f--�t�f]- -------------� ---------• —D 6 D� JOB ADDRESS AND LOCATION___ ----- ---- - - - ---•�- Phone............... Owner s Name '�ysl - - - -- Phe_ Address--------------------- ----• ----------- ..�a.--�•�f�-------�. - -- -------- •- ---••- ---------•-----------------•-•----• -------------•--- Contractor's Name_ _______________ ___Y_._ -- . - Motel ❑ Other ❑ Installation will serve: Residence ❑ Apartment House ❑ Commercial x Trailer ° r# ❑ /3 Number of living units: ........ Number of bedrooms -------- Number of bats ! of size �• «' _-••-•- Water Supply: Public system 171 Community system ❑ Private)g Depth ro Water Table lK4- ft. Adobe Hardpan ❑ .t Gravel ❑ Sandy Loam ❑ Clay Loam C3 Clay ❑ .� Character of soil to a depth of 3 fee Sand ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ Previous Application Made: (if yes,date--------------- ----i No ❑ y. TYPE OF INSTALLATION NDPECI wed TIif pu: sewer is available within 200 feet-) r (No septic tank or cesspool P . i �. /1L.- _ :-- ------._.Mate jai--�-- -----•----• Capacity—w7 Septic Tank: Distance from nearest well_.------ Distance from fou�datiLn Liquid de th___1��----------- v r Size_ y-� q R No. of compartments_________ --------------- , 4--•----- Distance to nearest lot line! ..-- Disposal Field: Distance from nearest welL. D---4--�en�th of from line�8t+� � - •W+dth of firench--.---.�;� i Number of lines.. 7 ----Total length SQ I Type of filter materiai.,5,Ji Depth of;filter material___- -- - ! �jJ Distance to nearest lot line 17 - + Distance from foundation__ ________. ' Seepa a Pit: Distance to nearest well/jP-0 Size: Diameter----3-3-----------�Depth------ •------ I Number of pits`:i---f-------------Lining material Number .--- ,��" m _.------•------•--------•- Distance from rnearest well-----------------Distance from foundation_ _.:.__------_----- nng _...- Li uid Capacity gals. Cesspool: Depth_ Size: Diameter---- -----•--•---- ❑ Dfrom nearest building Distance from neares# well---------------------------- e Privy: --------- � '" ❑ Distance to nealres# lot line_-_____- _ ------------------- I -------- r Remodeiing and/or repairing (descri a):-- --- - --- t, -------••--- ----------------•-------- ----------- ---•-•---•--•-- -I--- -------------•----------------- -------- -- ---------- .-- s� �. '--•-- ----------- r --- -••---------•--•-- ---------------------------------- ----------------- ---- ..� .....�m_ r-� i I her certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e aws, aVrulrand regIations of the San Joaquin Local Health•Distrt . II (Owner and/or Contractor) ---- (Signed) ---------Si ned -- �._ ------------------ ( 9 )----••-- -•--- -•--------- -----(Title)---- - -/------------ -------------- BY: _ (Plot pian, showing sire of lot, ---cation of system in re ation to wells, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE O LY I DATE-------------~------------�---•------•------•------ - APPLICATION ACCEPTED BY_ •-.---- --- -- DATE ---------------------- ._. REVIEWED BY----- -----••-------- -------= ----- BUILDING PERMIT ISSUED..... ---------------------------•-• ��J�'� --•- A-terations and/or recommendations:.. " ------ - -- -- --------•-------- ----•- ----------- ---------------------------------------------- ----------•--••---- • - ------ t _..__•------ •------- --•---•----- •---•-•------------------ ------------------------- .--- --------- 4/ _j Dete_ . ... ------------- FINAL ----------FINAL INSPECTION _ --- - ------ _ " �� _ - • SAN JOAQ LOC HEALTH:DISTRICT t— 2o5 west 9th Street " ► ti�144"Syeamore Street 136 South American Street 300 west Oak$vraet "�. - , - rTracy,California � �� Stockton,California Lodi,California Manteca,Califonia. ES 9 REVISED 8.59 2M 5-E2 A-MAS J - -