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FOR OFFICE USE: s 31J Permit No. _ 76 = "C ----------- �- APPLICATION FOR SANITATION PERMIT -- --------- __. (Complete in Duplicate) Date Issued - fes ----- -------------------- - This Permit Expires 1 Year From Date Issued 3 —C7 t7 —Z-6 d. _ ____ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her 'n descri e This application is made in compliance with County Ordinance No. 549. '19-0 -- 3- 0 :3 2 LA). 14 Lt i2..ra122 - �------ --4,0_&�-------- JOB ADDRESS AND LOCATION,_. P 1 - hone------------------------------•---- + .- - ------ ---------------------------- Owner's Name--- ' Address 1 __ �. �--r--- -- Contractor's Named -- Motel Other ❑ Installation will serve: Residence ❑ Apartment House,❑ ommercial ❑ railer Court [I ❑ 1 q Number of living units: _A 5" Number of bed - Number of hs ______r. Lot size'^'" r th to er Table __--__-- Water Supply: Public system ❑ Community system 01iariva DeP ft_ i Hardpan ❑ Sand Loam ClaylLoam ❑ Clay ❑ Adobe❑ P Chafactei• of soil to a depth of 3 feet: Sand ❑ Gravel Oil Y ❑ FHA/VA: Yes ❑ No ❑ .. rf— ,: No ❑ New Construction: Yeso �,v„ . ,PrMtou .Ap0icatiUn Mace~ � t 1 TYPE OF INSTALLATION ANDREGjlFlC i.TIONS: i + septic tank or cspool permittedif p' blie i�`availableithin 200 feet.) No p z i M�` pial---- -= E Disance from Mun -- - � 1'Se tcank ��.6Dist'a.ncefom nearest well___ ..-__.__-" +�Ca aci� Liquid de th ;-- - ---: ).d�� I �• SizeV. 3 P. p ? 4 p � No. of tom. artments___ �� Disanee from f�undatio __ Distance to nearest lot line__ ___---------- Distance __. .�—b —t ,< < - w a Dispos l Field: Distant rpm nearest Le Sgt 5f each line_ "�- ----- Width oftrench_.�. ----- _Number�flines- ------------ -- } - _ M. -------Total len th�___--"------ -��-------- C .• •r-TYpe Of fid# r material._ __ _Depth of filter C Distance to nearest lot'line____--3___-: Distance to nearest well-._.__�'______ __..__Distance frorn undation_.__.�______ _ _ � i Seepage Pit Linin material_ Size. Diameter ------ -----Depth- ----------------------�------- ❑ Number of pits_'----------------- g _i_ - .: � � Cesspool: Distance from nearest well_________________Distance from foundation------- Linuid Capacity ( gals,._. Deth ------------- q p Y--------------------------.- ❑ Size: Diameter- --------------------------- --- - P 1 1 __.--__..Distance from=riearest`building"""'" '--�""-� Privy: Distance from nearest well--------------- --------------------- ---------------------- ----- --- ---- --------------- -•----- Distance to nearest lot line--------------------------------------------- i ' I ------------------ ------------------- Remodeling ------ --------- ------------------ �L----- l Remodeling and/or repairing (describe)_-" ---- n------------ 2_ -- — ----------------- ---- ------------ ------- I --------------------------------------------------------------- ------------------------------------------------------------- --------- -------------------------------- -------------------------------"----------------------- L k I hereby certify that 1 have prepared this application and that the work w'I be done in accordance with San Joaquin County V ordinances, Stat ws, nd rules and regulations of the San Joaquin ocal H lth District. i -- ------- ---- Contractor( �} Si ned --- ---- -- ------ - - - -- ( g (Title)-------------- --------------- --- ----------------•-----------------,..__ -------------------- BY�------------'"-"-----'" buildings fete; can be placed on reverse side). , (Plot plan, showing size of lot, location of system ' relation to ells, -� l FOR DEPARTMENT USE ONLY ' ----- -- -- -- ---- DATE---- _� � �� ------------------- APPLICATION ACCEPTED BY--- ---- -------------- ---- ,�" )ATE. REVIEWEDBY------------------------- ----- ------- -- ---------- -- ---- --- -- ----------------------- ---------- DATE-------- --------- ------- ------ -------------- BUILDINGPERMIT ISSUED--------------------------------------------------------- ---_ ------------------------------------------------- ---•-------------- ---------------------------- ----------- Aitera#ions and/or recommendations:-_____.__..__---_. ________________ k -------------------------------------------- ---------- --------------- -------------------------------- ----------------------------------- ------------------------------------------------ ------ ----- ------------------------------- --------------------------- ------------------ ---------------------------------- -- ------------------ ------------ k FINAL INSPECTION BY -- ---- SAN J4A yjj1 LOCAL HEALTH DISTRICT u 92os West 9th Street 300 Wes!Oak Street 124 Sycamore Street 1601 E.Haselton Ave. Nlonteca,California Tracy,California Lodi,California 4 Stockton,California . AR,•*y.y 4 F.P.C O.