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APPLICATION FOR SANITATION PERMIT,?-dl Permit No.,J.— .7-______ (Complete in Duplicate) 71"17 y Date Issued .. / S7, Applica+ion is hereby made-to the San `Joaquin Local Health District for a permit to construct a n ll the work herein described. This application,is made in compliance with County Ord' rice No. 5 9. I ---- JOB ADDRESS AND CATION_____" r-------- ----------:- a e ' " ---------- Phone.__ c- Owner`s Name------------ ••--�-��------- -------------------------------------------- ---------- --- --- --- Address ----•------------•-------- � � . ry C-1 Contractor's Name ------ - ------------------ Motel Phone q6 O ---------- ------------••-•------- -------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _ Number of living units: -t Number of bedrooms 14__ Number of baths ._____ Lot size ____. _____________________ ________---- . Water'Supply: Public system Community system [I Private ❑'" Depth to Water Table Character of soil to a depth of 3 feet: `Sand E] Gravel ElSandy Loam ❑ Clay Loam❑ Clay ❑ Adobe 2---H ardpan E]Previous Application Made: Yesl. ❑ New Construction: Yes:❑ - No ❑ �t�4rs 'o 7e7 TYPE OF INSTALLATION AND SPECIFICATIONS: IN { (No septic tank'cr�cesspool permitted if public sewer is available within 200 feet.) w tic T k Distance from nearest wefl___'______.______DIstance from foundation__________________.Material-------------- ___.______________-----------____. �r No of compartments---------------- --------Size-----:........... -------------Liquid depth--•--_------------------Capacity----------------------- Number of lines r _ of line__!_--''___ r [� Barest well-_>�`G+�t.r._.D�stance from foundation___ /' �1 osa Field: Distance from n 3 6� Length of each line__ _ _------------_Width of trench___�_�"______________-___ _ --. _ ___.Dis nce to nearest -c� d p R ,1 p------- Total len Type of filter materiaf___ d - �_De th of filter material__._-1.O _ gth- Q-�________________________ p t fr m foundation__l� _...___:Distance to nearest lot line_____ . ._ e a Pit:F Distance to ifsA- - w------__�Lining____D trial e A � Size: Diameter_ Depth dam______________________ _ .. Gi'/mow ®®r. F / I�.umber of pits_' _� - - Lining material __ ___ 4------- P -� Cesspool: Distance from nearest well-----------------Distance from foundation---_----------_------Lining material____________..._____------_-________. ElSize: Diameter- `-------------- ----------- Depth------------------------------------------ ------Liquid Capacity-_-- }---------------- gals. Priv Distance from nearest well------------------------------------------------ F-1 ____________ :_______,___.________Distance from nearest building___`-----.__._____________-__.___._-_-.-. Y=: , ❑ F - �- - :. ------------- Distance to nearest lot line-----------------------------------------------------•- --------•-•----------------------------------------------------------------- R# Remodeling and/or repairing (describe)---------- --------------- ---------------------• ----------------------..-.---.-.---------•--•------------•------••-----------•---------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------r i 1 -------•-----------••-----------------=-- ---------•---------------------••----.--•---------------------------•--- 4 _ _________________________________________________________________________________________________________________________________________________________________ --------------------------- I hereby hat I have prepare this application and that the work will be done in accordance with San Joaquin County ordinances, St fe laws, and rules and r ulations of the San Joaquin .Local Health District. �+ ---- ) ` (Signed) • - ------------- ------------------------- - ------ - ----- ------------------------------------------_ • Contractor ----------------------- By-....----------------------------------------L-------------------------- ----------= (Title) (Plot plan, showing siie of lot, location of system in r tion to wells, h Idings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY t =----------- -- ----------------- --------- ----------'--------- DATE W--------------------------------------------------- 1 REVIEWED BY DATE --------------------------------------------- BUILDING PERMIT ISSUED----------- ----------- DATE-------- 7- ----------------------------- ----------- - tAlterations and/or recommendations:--------------------------------------------------------•-•-------------------------•-•------------------ ----------••------------------------------ ia4 •--•--------------------------------•----•------------------ ---------------------------- --------------------------------------------------------•----------------------------------- r -------- FINAL INSPECTION-BY:- �- .Date-------/------ -: SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California S ES-4-2M Rovised W-2100