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FOR OFF U�E; '- I. �I x, Permit No. _ `5- --:....,•- „—o ,-, -:"APPLICATION FOR SANITATION PERMIT --------• `--------- -- --------- ----- ""---- (Complete in Duplicate) Date Issued ---------------- This Permit Ex fires l Year From Date Issued Application is hereby made +o the San Joaquin Local Health cDistrict ffor'apermit to construct and install the work herein describe . This application is made in compliance with County Ord d �4'. ------------------•------------•-•----•- --•--�--•-------------- J08 ADDRESS AN LOCAT N____._ ..__ __ Phone 4 l Owner s Name r „ -•----------------- ------------•- 3 ---------- ...... Address..----------------------- T "r Con}rector's Name_.__ ___ Trailer Court [3Motel [3Other 0 + lnstallation will serve: Residence 1/Apartment House ❑ Comrnaraal ❑ Number of living units: - -- Number of bedrooms�- Number:of baths -.- Lot size • ft Private TO ro Water Table Water Supply:, Public system ❑ Community system ❑ E Adobe Hardpan ❑ , i Sand Loam❑ Clay Loam ❑ y Clay ❑ Application made: (if yes a}• Send ❑ Grave! ❑ e No FHA/VA: Yes ❑ No ❑ Character of sod to a depth of 3 fe New:Cons+ruction: Yes ❑ � � - P previous date---------- ----- 1 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: a cesspool ermined if public sewer is available within 200 feet.)(No septic tank or cessp p ' w anlc Distance from nearest welt-----------------Distance from foundation---Liquid de }h" Materia-.-:: :-Capacity..______."- -�---• No. of compartmeri#s___________ __ i Size----------•- P. r -• Distance 'to new lot line---- ---•---• Id: from nearest ell. Q------- Air Distance from foun anon_._ i o � - -Len th of each line...........:..�'�---•-Width of trench---"---_--�-- -••-------M--.,- —'Distance Number of lines - g f i _ ------------ I Type of filter materia._._ f" - - . Depth of;fil�er material.----__.--• Total lengt __---.- I f- Dis+anc m foundation--- s_Q. - Distance�to nearest lot line____-•-------•- Seepage Pi}: Qis#ante to nearest•well fL3--- - ----_Depth------- -- --------------- T I Number of pits1.._ ------- Linin material_ :_D�'�r----SI'Ze: Diameter-__az- Distance from nearest well_-______.__-•-•--Distance fro foundation.__.----s_----.----.Lining,material.__."._.__---"----- gals, I Cesspool: _.__Depth--------•----------•----------------------- Liquid Capacity 9 ❑ Size: Diameter.------ r-------- ---------- I Distance from'nearest well_____________"---- ---- Distance from nearest building_.__...___-------------••--- Privy: ..• E _... --------•------- ------------------- ❑ -------------m-------------------------'- Distance to nearestof me____________________ ,. ` Remodeling and/or repairing (describe):- -------------------------------- - -----•----------------------- __ -_.----------------------------------------- - - ---- - -- - - -- r -----------•-- -------•-•-------• ; ----•------••----------•-•----- -••--------------- ------- done I hereby y that I have prepared this a olf the San JoaquinhLocalkHeall Health n accordance with San Joaquin County ordinances, to aws, ander es: nd re la Contractor) l t -----(Owner and/or Si ned ------- --•- - -------- 0 BY: ;_ -------.-__ - 1 (Piot plan, showing size of lot, location of syYemool t lotion to wells; buildings, a+c., can be placed i n reverse side}. FOR DEPARTMENT USE ONLY : APPLICATION ACCEPTED BY ----- - �' ' "" -------------- -----------•---- ----- DATE-// -- ------ J --'�-`----------- ----- DATE ._.._... iREVIEWED BY------------------------------ ------ ---------------- ------------- ------ DATE------- ---------------•--------------•-----------= BUILDING PERMIT ISSUED r� CL_- - r . �.� . Alterations and/or recommendations:-- �."._�i.l - C --- ----- ---------------•----------- ----------- ------------------------I —-•------- ----------------------------- Date.-•-I/ "/--, f -------- ------ i -- ---•--- ----- - ..._-... .-- FINAL INSPECTION BY:./-_- ----- - - -"--- • - - ----------------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 91111 Street 300 West Oak Street 144 Sycamore Street 130 South American Street Manteca,California Tracy,California Stockton,Californla Lodi,California E5 9 REVISED B-59 2M 5-62 ATLAS M