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f Permit No. .--�f / APPLICATION FOR SANITATION PERMIT 7 (Complete in Duplicate) Date Issued ____ { Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San This application is made in compliance with County Ordinance No. 549. ' 77 -- - '_ JOB ADDRESS AND LOCATION----------2s 1----W--� �1` ..� ---- ------ �_,e --------- �lc_ra__ Owner s Name_________ _______" f r` '-c` --1-------- L-- Address---------------- --��--•----------- :�-••-- 9 .__ � �r�_Tr�J,? -------------------------------------------- - Contractor's Name------------- Motel ❑ Other [ICommercial ! Trailer Court ❑ Installation will serve: Residence MK/Apartment artment House ❑ ❑ I Number of living units: -----/_ Number of bedrooms _Number of baths/------- Lot size ------ -------------= t Water Supply; Public. system Q/Commuriity system F-1 Private ❑ Depth to Water Table- ,�1� ft, I Adobe ar pan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ lid^ Previous Application Made: Yes ❑ No [ New Construction: Ye No BHA/VA: Yes ❑ —No X I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspoolpermitted if public sewer is available within 200 feet.] l foundation //---------------------- Septic nk: Distance from nearest well__---Distance from Caufiy No. of com art'e;ts----- ------------ --Size__-_-- Liqu -2 -� id dep}h--- G"� p i } pisposal eld: Distance from nearest well.... Distance from foundation__,/°___/------Distance to nearest; lot line�5"_"`:-----•. Length of each line_________ ____________.Width of trench- Number of lines_.,__'_1------------- ------------ Type of filter -----Depth of filter material____l_�'___-_'_____-Total length_.____rT ________________-________ # Seepage Pi}: 1 10 Distance to nearest well ---------Distance from foundation---Z°--.....__.Distance to nearest,lot li�".�---------- r Number of pits:----- -�----------_Lining material__!'p. ----.Size: Diameter---------.�---------- Depth__t��1----------------------- [, Cesspool: Distance from neaest well-----------------Distance from foundation_-______ "--------Lining ❑ -------- ----- -- --------------------------------------- material_______'_._""__.__._-_"____-__----.gals. Size: Qiameter � - --------De Depth------------ ----- Liquid Capacity 1 Priv Distance from nearest well ........................-------------------- --------_- Distance'frnm nearest building----------#------------ ----------- ai - ----------------------------------------- Distance to nerestlot ine------------------------------------------------------ .e -------- -------- -----------------•----- . a. - ------------------------ e) - . _Remodeling and/or repairing (descb "--i ---r _______- , ------------------------------------------------ ---------------- --------------------------------------- - - - t j prepared this application an Sa------------------ ----------------- ---qui l ' I hereby certify that I have p p pp d that'the workwill'be done in accordance with San Joaquin oun y ordinances. State laws, and rules and-regulations of the San Joaq Loal. Health District. •� �1J -------(Owner and , r Contractor] t (Signed). : By: ------(Title (Plot plan, showi "e iA lot, ocation of system in relation to we s; uildings, etc., can be placed on reverse side) i ! FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY-------------------__ DATE-----------! 1 • -- - --- - ✓�r�--------------"---------- DATE--------- ----- -----------=-------�---------- ---- REVIEWED BY----------------------------------•---------:.._ ---- ------------------------------------------------------- BUILDING PERMIT ISSUED------------------------ - ------- ---------- -------------------------------------- Alterations and/or recommendations------------------------------------------------- ----------�---------------•----- -----•-------------------------------------------------- Alterations �P-__--_- - c == ©" `--------- €�c s-1 c`' f ' f T !`{1CS 1 �� -------------------- t { -----------------------------------------------------•---------- -- k } -------- ------------------------------"------------------------------------------------ ------------•----------------------------------------------------------------- -------------------- -----"------------- '-"----- ' ------------- =q------__--- F- .. v....-v �. • - bate-------- ---��--�-----4;))--�-�------ -----"---------'------ FINAL INSPECTION' BY."_____ - ---- ----------------- - ' SAN'J AQUIN LOCAL HEALTH. DISTRICT ' 132 sycamore Street 814 North "C" Street r 130 South American Street 300 West Oak Street y Lodi, California Manteca, California Tracy, California -Stockton, California ES-9-2M Revised 1-57 F.P.00. _