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..-�-J---r-�--- APPLICATION FOR SANITATION PERMIT Permit No. _ (Complete in Duplicate) Date Issued ---:_f.� pion is heremade to the San Joaquin.Local Health District for a permit to construct and install the work herein described. Applica Y This application is made in.complianc6 ith.County Ordinance No. 544. p70 ' f-70"7 14 - .----------fes` --------------- JOB ADDRESS AND LO ATIOZ164- r Phone------------------------------------ Owner s Name_-_.__... --- - --- ------------------•- � •-- •----------- Address one : Ot er Contractor's Name-------------------- Motel ❑ 0""' �A artment House ❑ Commercial ❑ Trailer Court-0 � � Installation will serve: Residence ❑ p �-Q -1_� .__. _____-: Number of baths!-- Lot size _-:_ --- Number of living units: _4' -Number of bedrooms -------- Water �� Private ❑ Depth to Water Table ft• s Water Supply: Public system Community system ❑ � Clay Loam ❑ Clay ❑ Adobe[��ardpan ❑ ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,,-` h x Materia ' "``�"�--------- A+ Septic Tank: Distance from nearest well- foundatin_ depth -foundation-- ..........Capacity �� No. of compartments__.-._L .Size---sl__�---� �Q- Liquidp �� IP t lot ion -------- �i - nce Disposal Field: Distance from nearestwell. "die' DLenath of reach lineom aati f0-- -----------Width ofttrenchQs '/— e----_----.------- ` �.- Jf Number of lines_-._______---- 9 Dep}h of filter material--- leng}h__---_-ti/ -- Type of filter material.--/1__ `pp �:.. L Distance from foun ation__/-Lf_1-- -i stance to nearest lot line o.5---------tea ( Seepage_Pit: Distance to nearest well �1. -- -----.-Depth.'_Q.40---------------- �} " ize: Diameter._ ..____ _-- P �-- Number of pits_----`-------------Lining materiaL .C- ---------- Distance from nearest well-.-_-___--_.._--Distance from foundation---------------- -- Lining ma}aria!------------------------------------- Cesspool: __.____.- ,---- -----als. � Cesspool: --------------------------------- -- - - - --------Li u id Capacity----- ---------------------9 ❑ Size: Diameter------------------- ------------------Depth - 9 Distance from nearest building------------------------------------------ Privy:. Distance from n eares} well----------------------------------------------- ------------------ ❑ Distance to nearest lot line-------------------------------- - ---------- --- --------- ---- ------- Remodeling and/or repairing (describe :____ -- --- - _-__--___-_- ---- -------- -- -- ----- -- ------------------- ------------------------------------------------------•---•---•---------- -- ! hereby certify that I have prepadis'aapplication the San Joaquin-that the worcalkHeawill lbeth done cin accordance with San Joaquin County ordinances, State laws, and rules andregulations t. ontract ------ ►,.:: --- -------- (Signed) - ----{Title)----` i (Plot plan. showing sire of lot, loc onofsystem in relation to wells, buildings, etc., can be place on raver side). i FOR DEPARTMENT USE ONLY ----- ---- ------------------------- ------ DATE----�------------------------------------------------ DATE ------------ -------------------------------- APPLICATION ACCEPTED BY--- DATE-------- __—-x---------- ---- -------------------- REVIEWED BY---------------------------- BUILDING PERMIT ISSUED-------•---------------------------------- ------ --------------------------------------- --------• DATE--- � ------- -------- �------ ---------------�----------- Alterations and/or recommendations__________________ ___ v _.. ri- ------ - ----------------- -------------- -----------I-----------------I—,--------------- ----------I------------------ ---------------- --- ------------- -- Date.---- ------J------ ----- ------ ------- -------- - ----------------- FINAL INSPECTION BY---------------- ----- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North 300 Wes "C" Street West Oak Street 132 Sycamore Street ti 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California yEgg. 145446 ATWOOD __