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_w FOR OFFICE USE: -------------------------- •' Permit No. - APPLICATION F®R`SANITATION PER (Complete in Duplicate) . Date Issued -- _ _ _--_.-_-_- This Permit Ex fres l Year from Date Issue plication is hereby made to the San Joaquin Local O Health District for a permit to construct and install the work herein described. j ith County i ��. j lication is made-in compliance w � V pP p --- -- DDRESS AND LOCATION.. - 1 Phone.':—'l-- --•--- I `ane_ ---------L.0,6Y. -----------------= -------•----------------------- E Phone Ql'.�1L aQ---------------------------- •-------------------- - actor's Name____ Motel Other ❑ - 2-"'Apartment House ❑ Commercial ❑ Trailer Court ❑ ' I--stallation will serve: Residence �Ap ----------------- Number of living units: ___ Number of bedrooms _-9-- Number of baths ______-_ Lot size ---------- -- -- ---=- I Water Supply: Public system ❑ Community system ❑ Private_ff'Depth to Water Table _'T ft• of soil to a depth of 3 fest: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Characterr hcation Ma e; (I..f-yes;.date :---� ------- TYPE �-lNew-Consfruction::.-Y,es-❑-;-No- FHA/-VA:Yes ❑ . RreviousApp No septic tank or cess ool SPECIFICATIONS: ermined if public sewer is available within 200 feet.) TYPE OF INSTALLATION AN_D Septic Tank: P Distance from npearest well___ Q-- --Dis#ante from foundation__..j0_-__.--._.Material- . . Gtr . cc q CapacltY •-� . d No. of compartments_-. ----Q------------- Size_ Liquid depth 17�.z _ w --- -----5nce om Field: Distance from nearest well__..____=----_ Dena h of each lme_ation1yOO--.- Wath of trench_ ----------------------- l Number of lines g --.Total length_------------- -- --------------------- Type of filter material_��+-t_,�QCr- --=Dep}h.of filter lnaterlal___..�-�_---- - Distance to nearest lot line----------------- Seepage Pit: Distance to nearest well----------------------D•++stance from foundation---.----------.-_-_. Number of pits- ------- ------- ---Lining material_------ ------ ----.Size: Diameter.----------------------.Depth--------------------------------- ❑❑ �.. Rs D,i Distance from foundation foundation___.---------- ------L ini ail ------- ---------- ------ . Cesspool: Distance from nearest well------ - Liquid CaP iY- ---------------- -- . •-------------------- gals Size: Diameter__ Depth-----------------------------------------c _ - ------- - --- ne�rest builsn9-- - ---------- ------ Disariefrem Privy: Distancefrom nearest we ------------------------------ -__ ._ - Distance to nea�es} lot ine------------------------- - ----------------------- --- 0 Remodeling and/or repairing (describe _.-- --- --------------------------__----•----------------• :. ------------------ __ _. ------.-------I---------------- --------- --- ------ ------ ----------------------- - =-•------------------ F 1 hereby certify that I have prepared this application and$+hat the work will be done in accordance with San Joaquin County b n Joaquin Local Health District. ordinances, State laws, and rules and regulation's of the San _ __-(Owner�-and/or--GnnraCIO r) =' 9 ( ned) 9 ------------ (Ti#Is) mag =--- -- - ------- By: _ [Plot plan, showing sr { o�1.1, 1.caion-------------------- system.in relation to a , buildings, etc., can be placed on reverse side). _ FOR DEPA MENT USE ONLY -�067 � �-- ----------------------------------- DATE------------------------------------------ --------------- APPLICATION ACCEPTED ---- ------- REVIEWED BY = ----------------•----------------•--. DAT --------------- - -•-------- --------------------------- l - - DATE - 3 BUILDING PERMIT I55 ED --- ---------------------•------------------ --------------------------- ------ ------- Alteratioris and/or recommendations----------------- -_._ ______________ - y --------------- --- - - ' _' ----------- 1 Date.------.9-- 9-947-• ------- .---- FINAL INSPECTION B --. l -- -- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maselton Avt. 300 West Oak Street 124 Sycamore Street 205 West 91h Street � Lodi,California Manteca,California Tracy,California Stockton,California CS 9 REVISED B-59 3M 3-'63 F.P.Ca. _