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Permit No. ........... 1 APPLICATION FOR. SANITATION PERMIT (Complete in, Date Issued Local Health District for a permit to construct and install +he work herein described. Application is hereby made to the San Joaquin11 v This application is made in compliance:wi.th County Ordina e,No_ 49. ,�y s JOB ADDRESS AND L ATION_________ ____!-'� ------- Owner's Name- r �--�^ ------------ Phone---•-•-----------------•------------ .:� Address------------------- -------- �- - Contractor's Name-------- Phone_.. --------------------- Motel Other Installation will serve: R �denceApartmen+ House ❑ Commercial ❑ Trailer Court ❑ ❑, ❑ r - -` Number of living units: _ __ Number of bedrooms ®_._ Number of baths -_ Lot size __ _' - f i ` y Water Supply: Public Sys [�]r- ommunity.system ❑ +P'rivate ❑ Depth to Water Table _ Pf#. Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy.Loam ❑ .Clay Loam ❑ �lay ❑ nAod be Hardpan ❑ ' - PHA VA: Yes ❑ El Previous Application Made: Yes Q No New Construction: Yes } o ❑ FHA/ VA. OF INSTALLATION AND SPECIFICATIONS: +. (No septic tank ordcesspool'ptermitted if 61i ewer is available within 200 feet.) �.c 'r" '- ------------- Septic Ta k: Distance from nearest well________________Distance from foundation__ z No. of compartments_----s ----------------Size---- _ 1. Liquiddepth___-- .�---------- --e apaciot}_1-� 4,0---f =� sem__ If Disposal Field: Distance from s"earest well -Distance from found tion_-- _ _ ��3istance to est l l e_._ -_. --_-- Number�bf lines------- -- --_--- - -- - Length of each line______------« Width of trench/-X'- t Type of filter material_�z-�� --Depth o f filter material �------------Tota4 length__ __ _______________________r ` n _ t __ _.Distan�e'to nearest lot line---�4------- Seepage rf: Distance to neares well_ - Distant om oundation_ _ Lining material��=-----Size: Diameter---3 --------Deptn__ i, '__ .--1 Number of pits-- _- -_--° 4 Cesspool: Distance from nearest well.__________-_=:_Distance from foundation___________________Lining material_-____--_--_______----_________- --n.Deth-=----------------------------------- Liquid Capac'stY gals. � ❑ Size: Diameter�.�_:_-==------------------- P Distance from nearest well-------------------------------------------= ---Distance,from.-nearest building_____-______.___------------------------ Privy: t ►: -------------------------------- ----------------- ----•---------------- ❑ Distance to nearest lo+ line---------------q= ----- --------- Remadeiin and or re 'airin describe� -- -- - - 4 g p g ( }` ` _� _ t. �. _______________ �k � ____________________________________________-_______-__-__-__._--_____________-______._____..___ 3 411- _________________�_.__.____ I hereby certify that'l have pre ared this application and that the work will be done in accordance with San Joaquin County i ordinances, Stat laws, and-rules d egulations of the San oaquin Local,Health..District. s --------------------------------------- -- ner and/or Contractor) ``'' ---�-- (Ow d/o ret ori (Signed)------------- - -- --------- -- (�1�_ ff------------------------------------------ - Title----------- -- (Plot plan, showing size of:lot, location of system in.re tion`to wells, buildings, etc., can be placed on reverse side). ' tt _,..,,FOR DEPARTMENT-USE ONLY ----------- --------- --------------------------------------------------- APPLICATION ACCEPTED BY- -- -------------------- -------- -------------- -- DATC _ REVIEWED BY "------------------------------------------------- DATE__. .. = '1�..- DATE . BUILDING PERMIT ISSUED---------- ------ ------------ ------------- - ; -: mendations,�- t------------------------- ----------•----------------------------------- -------- __1. -------,c =-- ------ -� -,C _ -------- terations an or co ---------1--`rr� r - J1 Ott Lir ate. ---- N ` _ ' f Date--- ---- - FINAL INSPECTION' BY:__-__�„__- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street v 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California tvlantaca 'Celifornie Y. ES-4-2M Ravised 1.57 F.P.CO.