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vf� Permit No. S_�-W APPLICATION FOR 'SANITATION PERMIT (Complete in Duplicate) Date issued ermit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health District for a p This application is made in compliance with County Ordinance No."Ll 549. ------------- B ADDRESS AND` ` CATION f _ '�- �. ------------ ------- ------------ JOhon ----------------------------- 6 -• r -------------------------- __¢__-.. ........ ------ ----------- ------------- -------------------- ... ............ - �_ ,m ,. R:. Name-------- - --�- -�-�-�-- � ----•-• -- --------- Address_ -- ------------- Owner's G' Address----------------•------ ----��=#-'�:1.�:.--------------•-------------•------------------------------------------------------------ •------•------------- ------------••- Phone�G -- --- -- - - Contractor's Name=' _ --- r " " "-. Motel Other ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Installation wiil serve: Residence 0k, AP -----,._...------- Number of living units:._.._-._Number of bedrooms -.-0 Number of baths -_,V L t size ---- _ ble Water Supply:- public,system Community system ❑ Private.❑ Depth toWater aLoama❑ Clay ❑ Adobe p( Hardpan ❑ k Character of soil to.a'depth of 3 feet:) Sand ❑ Gravel ❑..Sandy Loam ❑o Y FHA/VA: Yes ❑ No ❑ F Previous Application Made: YesNo [] -- New Construction: Yes:❑ # F 1 TYPE OF INSTALLATION'AND SPECIFICATIONS: Mater^al. (No septic tank or cesspool permitted if public sewer is available within 240 feet.) _ ------- S tic Tank--r Distance from nearest we}}____"" -""_-"_..Distance from foundation de th_...----.-"-I---=------- -Capacity----------------------- Size -" _---..------"--- No. of compartments. Size---------------------- No. --•- -- Liquidp ` t?_-p_.._.Distance to nearest lot line-.. • Distance from•nearest1well_--�"� Distance from foundatiori.-.. Width of trench..... isposal 1 Len th of each line....-_._._ .5--- Number of lines-._. 1-.----- g ' De th of_filter material. ._ - Total len"jth..`."- 1_6--•----• _, Type of filter material_ /! - - , - rr�- P _ _, .. „� � oundation------- ____.Distance�to nearest lot line.-."..._-._._..." O ------------- Seepage Pit; Distance.to nearest well:_"------------------- -----------__4 Distance from f Size: Diameter Linin mater a ❑ p• material------ D stanceNLimber ofromsnearest well----------------- , _ _ g Distance from foundation.-_----- g Cesspool:' ------------- Liquid Capacity.. gals De th = ❑ Size: Diameter -- ------ ---------- - -.. -.. .Distance from nearest building " Priv � t c_Distance.:frcm'nearest.well-. _ '.-`- ,= Y.:-- , - ---- ._ _ --- -- -- -mss ------------- Privy-.- ^�• Distance to nearest lot line"'"`.'-`'-`'"`"'�=- - r k: ------------------------------- s ------ ---- --- r 4 ---- ---- '--" ----------------------------------- ----Remodeli g and/or repairing (dascribe�:_.__..-.. - - - ' . -,- ------------------------------------ f ------------------- ----------------- ------- --- ---------- - c ---- --- I - ----------------- -------- ---------------------------- ------- �..... _ clone with an Joaquin Coun 1 hereby certify that 1 have'-preparedut islations pl�cthe San`JoaquinLocalkHeal heDistr District. accordance +h 5f ordinances, State laws, and rules and g 1-., . y - ----------- --- - (Owner and/or Contract G� ---•--- -- r --------------- --------------------- ------ -- - - d/o (Signe )-- --_•- --�.; c--- ,,.. .�, t - ...(Title)--------•------------------ -------•-------- -:----- ---•---- - --- ------- ------------------------ (Plot plan, showing size of lot, Iota+ion-';f system in relation to wells, buildings etc., can be p ace on reverse side). t a FOR DEPARTMENT USE ONLY f 1 4 DATE j` ^"= r - - 1 DATE ,.4''�--!/- . � '' -- ---------- --- APPLICATION ACCEPTED BY------------ --" g t QATE------ ------------ ------------------------ REVIEWED BY------ ---------------•----------------- --- - ---- --- - _-" 1 BUILDING PERMIT ISSUED----------------------------------------------- ---- t----------------`----------------------------.------•-------------------•------- - - -- -- --- --- --- r Alterations and/or recommendations:----`------------ _,._....r, -------------------------------------------- ------------------------------- -----•---- ------ FINALIL L INSPECTION BY:.-- Y - Date_. SAN�OAQ IN LOCAL HEALTH DISTRICT 814 North "C" Street 300 West Oak Street 132 Sycamore Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California ES-4-2M Revised 1-57 F.P.Co.