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11l 1 � FOR SANITATION PERMIT Permit No. _ _-- ••-- �--- APPLICATION (Complete in Duplicate) Date issued Application is hereby made to he San Joaquin Local Health District for a permit to construct and install the work herein described'. This application is made in compliance with County Ordinance No. 549. -- -- --- JOB ADDRESS AND LOCATION-- = ------------------=--- -. Phone------------------------------------ Owners Name------ ---------------------------------------------------•----•"-- �cT - --- Address......--- --- Pone.-------•----------------- 2/- - ----- ------ Contractor's Name______:_ Yj- " "" Motel ❑ Other ❑ Apartment House ❑ Commercial Trailer Court ❑ ✓ �. Installation will serve: , Residence ❑ p ��--_-1149____________________ Lot size ---- - Number of living units: -_7-___lNumber of bedrooms _'-- Number of baths _ 'ft. 01 Private Depth to Water Table ft Iardpan Water Supply: Public system ommuriity system ❑ Sand�Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2 ❑ Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Y FHA/VA: Yes ❑ No ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Liquid de th--------------------------Ca ac-it I pt}c k; Distance from Barest well_________________Distance from foundation__.________""- ---_Material_"------ - Size ------- --- ........ -- -- a p' No. of compartments___________ ______ . L e om i is cs11id: Distance from nearest well-------- DLenanc th ofreach.l ne_anon "------------------ ----------- -Width ofDistance ttrench--st lot line------------ P . �- g Number of lines______________________ , _:_Depth of filter material----------------�----Total 4engt _____.------------------------------------ T - --- ------------------ Tyipe of filter material-___________-.-"_""-- p �_-"_. -"_�pistance'from fo ation___�_ is P. to nearest lot line u Seepage Pit: Distance tonearest well--- ----------- - -----Size: Qiameter_ _:-------------- Depth--- ---------------- 'E Number of pits_____/._----------------Lining materiae i Cesspool: Distance from nearest well-----------------Det+hce from foundation------------------Liquid Capacity_____----- ------ -----•gals. ❑ Size: Diameter------------------------- p ------------- 1 Privy: Distance:from nearest well----------------------------------------------- Distance from nearest bui4ding____._------""---- ❑ Distance to nearest lot ine------------------------------- ------- r ----------- �_gA41_ �__---------------------------------- -------- -1 _•-----•--•--_-"-_____-_ Remodeling and/or repairing (descrtibe):______.._: --- --------------------•--•------------•-------------------------- •-------•---- ------ -------------- ------------- --------ha}-I-have prepared this application and that the work will be done in accordance with San Joaquin County I hereby certify t ordinances, State laws and rules and egulation of the San Joaquin Local Health District. ��Contractor( ,.�-� .� t%✓- - ----------- ---- (Signed) (Tifle� +�� ---- Y--- ----- By:"------------------•-=------•------------ buildings, etc., can be placed on revers � e. (Plot plan, showing size of lot, loc n of }stem in relafion to wells, {- FOR.DEPARTMENT USE ONLY 3 ' -- -- ---------- ------------------------ ------------- DATE----`�-------------------- ----------•------•------- ----- APPLICATION ACCEPTED BYDATE-------------------------------------------------------- REVIEWED BY QATE- `--'---- ----------------------•------------------------------ BUILDING PERMIT ISSUED -- ..-- i . - Alterations and/)r recommendations;__.______ -- - - ---•----- --- -- - --- ----------------------- ---------- ---- ------ ------------ - ------------------•------- -_ _.: --------- -----------• ------ ---•---------- ---------- ----- ------------ Date--- a F --------------------------------------- FINAL INSPECTION BY _ t I SAN JOAQUIN LOCAL HEALTH DISTRICT I 132 Sycamore Street 814 North "G" Street i 300 West,Oak Street Tracy, California 130 South American-Street Lodi California Manteca, California Stockton, California ES-9-2M Revises 1.57 F.P.CO.