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l` APPLICATION FOR SANITATION PERMIT Permit No. ... .- � A ' ' F, (Complete in p ) . `• �licate - ;. Date Issued .: ` Application lication is:'Kdf,66 made to the San Joaquin Local Health District for a permit to construct and install the wor4e herein described: PP �.,, y o , This applications&s made in compliance with County Ordinan No. 544, �--:----°- Os , �_ _ SOB ADDRESS AND L CATION____"_ _____ E �- -------- Phone is-_ -------- Owner s Name `- ----------•----- ------------------------------ Address ---•- .__ - �`VA Q Ve------------ --------------- --- Phone_ i Contractor's Name___ ---- AR Motel 0Other 0A Installation will serve:, Residence [�partment House ❑ Commercial E] Trailer�Court ❑ i Number of living units: _ _ Y�lumber of bathssize ___: �-=: ---------------- 1 _u ber of bedrooms __ Water 5'u I Public system Col 'MUriity system ❑ Private ❑ Depth to Water Table ------- ft. pP Y� Y ' Clay Loa Clay Adobe Hardpan ❑ Character"of.,soil to a depth of 3`feet Sand ❑ Gravel ❑ Sandy Loam❑ y ❑ Y ❑ F ew Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ Previous Application Made: Yes ❑ No �� i TYPE OF INSTALLATION AND SPECIFICATIONS: k. No septic tank or`cesspool permitted if public sewer is available within 200 feet. , ' :. r Distance from nearest wel4______.-._-_____--Distance from foundation uid de0h Material _"__ Capacity ------------------.---- - q p Parity No: of compartments__.__--•------------ , ;l osal Field: Distance from nearest well_._.____________Distance from,-foundation ______-"_____--Distance to nearest lot IinE:--------_________ �- Number of lines-----:-------------------------Length of each line i "-.Width of trench --. • ____De Depth of filter -- ----�-Total IEngtli.�-`---------�--•------------------------- Type of f Iter material_____________________ p D ___Distance from foundation `____.Distance to nearest lot line__-_/_____-_, F Seepa e Pit: :. Distance to nearest well-904a-- pe th_-- ----_--- _--_---- Number of pits----!---------------"Lining ma#erial_ a__ Size: Diameter_ s� P W Cesspool: Distance from nearest well____-___"_______-Distance from foundation___" --.- ---=-.Lining material-------------------- k --Liquid Capacty ---------------------_-gals. Size: Diameter--------------------` De th = 1.1771 '' �- --Distance from .nearest building------------------------------------------- Privy: ------------ ------------ -------- Distance from nearest well---------------- -- Privy: ------------------- ---------------------------------- -❑ Distance to nearest lot line_-,- - ---- --- - --- ,: ' ---- Remodeiing and/or repairing 3 - -- - - ------ ------ - - -- 6 ____ �_______ - ___--------__________ _________________"._ 1 --------- _.___.__ ______ -P p ---- --•-.- PP Health Distric} rdance w ----------- I hereby certify that-I have prepared this-a lication and that:fhe wor wiN•be done m acro, with San Joaquin County ordinances a laws, and r les and regulations of the San Joaquin Local H ract Si ned o-St -- -- -� ------ "------- ----------- ----------- Cont or) t g )--- --------- (Title) BY= ------------------------------ " [Plot plan, showing size of lot, location of system in relation to Its, buildings tc., can be laced on reverse side]. c FOR DEPARTMENT USE ONLY T r - ------------------- ---------- DATE.-------- ------------�-------------- -----•----- --------- APPLICATION ACCEPTEb xBY------- - ---- ---------- - ` ` ---------� DATE----------------------------- -----••---------------------- ---------- - REVIEWED BY------ ------------------------- Y ----- -•----------- DAT,E_ _____ :: ,, BUILDING PERMIT ISSUED.___-.-------------=---- „�----.--_-_-_- -- -/ _�_ -4_<--- -2 Alterations and or recommendations:__ -- - - ------ - /- �-rte,- `- -�- - r�1` -se__l -- -- --•---F-f ------- ----------- . -- __.____.V____________________ _ --------------------------- __.r_--_-------_!_-"____--"__ __.__."_______."_________________ __ _____________"________-_____i Date--- -T__ -- -- i f .. ------"---------- FINAL INSPECTION BY----- ----------- ----k ------ SAN JOAQUIN LOCAL CAL HEALTH.DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Tracy, California S+ockton,_California Lodi, California Manteca, California Y� l;S-4-2W! Reviseci 1.57 F.P,CO-