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r FOR OFFICE USE: ----------------------------------------- -- ----- APPLICATION FOR SANITATION PERMIT Permit No. ------ ------------------------ ------ (Complete-in Duplicate) Date Issued _ ---------- This Permit Expires 1 Year From Date Issued ---- ----- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliant with County Ordinance No. 549. JOB ADDRESS AND LOCATIONZi?-._ -�--_ -------- ------ -- ---- - e k Owner's Name Phone f�-�/` Address �O ------- --- --- ---- --------------------------' ----------------------- --------------- r ' -- --- Phone. ' Contractor's Name---- # = Motel Othe- � , Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ r Number of living units: __�-- Number of bedroomsNum;;Dp6 baths __/___ Lot size _-.-_ Water Supply:: Public system ❑ Community system[] Private to.Water Table ____ _ ft Character of soil to a depth of 3 feet- Sand E] Gravel ❑ Sandy Loam [I Clay Loam El Clay ❑ Adobe❑ Hardpan t i Previous Application Made: {If yes,date--- ------ ------- I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ j TYPE OF INSTALLATION AND SPECIFICATIONS: -. -� w• -- i' (No septic-tank or cesspool permitted-if-public sewer is available within 200 feet.)"` • a-l- -..Material --- - ------ - --- ------ --�-------��-•��I Septic nk: Distance from nearest well--- fir ---Distance from foundation----/._ Size_ N r 9 P I/-�--- ----- Capacity_1s�4?___ No. of compartments._-- ------ - V fr__ .X�'---Liquid de th__._... Dispos Field: Distance from nearest well----Jia-�._._Distance from foundation--_ Distance to nearest lot line_4Fr---- Nu.mber of lines_-.------y---------- -------Length of each line_. ....�r,P'-'-----------.Width of trench.... -w--------------------- q Type of filter material-------- -�`-"- ----Depth of filter material----'-/' ___-- -Total length----- ¢* ------------- /-- See a ePit: Distance to nearest well-.___! a'.__--Distance from foundation___---4V-_/__--.Distance to nearest lot life-._.S---_.---_- Number of pits.-- -..�--_---Lining material--- - ------- Size: Diameter------3.�__.------Depths--;' -------------------- l Cesspool: Distance from nearest well _---...'r._.._.Distance from foundation........... ..... ..Lining materia _ �. . "e. ---------.gals. Size:,Diameter --- -------- --- t------'---Depth--.------- -------------- = Liquid Capacity I is ., building------------------------------------------- Privy:Privy: z Distance from nearest well___-- ____........................... .."Distan e from nearest buildm i""i„_'� i -._.:`------------------------•-------------------•---------------------------- i ❑ Distance to nearest lot line_________________ ' rt � ' INA Remodeling and/or repairing (describe) } --------- - -•----------------- ---------- -- ----- ------------------------------------- ------------ ------- -------- -------------- , 't p --------- ---.-`--- -- -----•--------- -------- ------_.el:- _ i - -- - --------- ...... ----" I hereby certif at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws and rules and regulations of the San Joaquin Local Health District. ' '1 -- -- (Signed).... and/or Contractor ---- -x.. _ (� (Title)----- - - x _ . By:-. g y g P l (Plot plan, showing size of lot, location of s st to relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY i 'r APPLICATION ACCEPTED ,BY___-. - -' DATE ---------------------------- fREVIEWED BY--- --------- - ----------- ------ '-- '------- ------- ---------- --------------------- --------------• ----- DATE-----------.........---------- ---------- --------------- ?� BUILDING PERMIT ISSUED-------- -- -------------------------------------------------------------- ................... DATE---------------------- ! 6 I Alterations and/or recommendations:.................... -- ---- •-------------~ ------------------- --- - '' ----- --- ----------------- - ------------------------'-'- --- -------------------------- ..... • '� ----------- ' - -------------/-------- ------------- ---------------------------------- ............. ' ------ ------- ------ - --- =- ------ - FINAL INSPECTION BY:- - Date. -67--- _. ------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press I �_�