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Permit No. P .... 111 APPLICATION FOR SANITATION PERMIT ' (Complete in Duplicate) Date Issued ---------- This -_/----This Permit Expires 1 Year From Date lssued Application is hereby made to the San Joaquin Local Health District for a permit to construct install the w4© ,herein destribe. This application is made in compliance with County Ordinance No. 54 ,.,, _. ::- JOB ADDRESS AND L AT10N_ J U L. _ ��; ; �- ------------------------------------------ ------ - Phone Owner`s Name--------------------------------- ----- Address----------------------------------15.. {�•��---• E/� ---------- - ------------------------- ------------•---- one_..----•----------•--•--•-------•-- P .Q Zf� Contractor's Name_______________ _ _ Motel ❑ Other ❑ Installation will serve: Residence �Apartment House El Commercial F1 Trailer Court ❑ 7010�L-Ll,-------------------------------------- „ _- Number of baths �Y. _ Lot size __ -_- Number of living units: ._/-___ Number of bedrooms - -3- � Depth to Water Table.>�0 ft. • Water Supply: Public system K Community system ❑ Private-❑ Dep Adobe �-lardpan ❑ Gravel Sandy Loa Clay Loam ❑ Clay ❑ ; Character of soil to a depth of 3 feet: Sand ❑ ❑ FHA/VA: Yes -No ❑ Previous Application Made: Yes ❑ No l�New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:J , i _ ..,--.-(No,septic tank-or cesspool permitted if public sewer is available within 200 feet.) /� Septic Tank: Distance from nearest well---,-- _____Distance from foundation-_16 --Capacity-.I -------- No. of compartments-_-- Size_, -----�D -well Distance to'nearest lo'line__s�--------- p Length of each line-----Z, --------------------Width of trench--o� 4g •- ' Number of lines 9 �' Total length �' A ---•-------------------- Type of filter material f -/ i Depth of filter material-__�8 _4- g _----__--_.Distance to nearest lot lines. - --•-- -- Seepag Pit: Distance to nearest well---------------------- from founds# :R- ion__,.f�� „ Depth___o ----------------- Number of pits------ -----------Lining material___-Q�� -- Sixe: Diameter. Distance from nearest well----------------- from foundation_---_-___----------.Lining material___-___-.-..__.--__-.-_------------s -___Li Liquid Capacity----------------------------gals. rn Cesspool: --- - qF ---------------- ❑ Size: Diameter--------------------------- Depth - �.; Distance from nearest building------------------------_-_-__-.---------. Privy: Distance from nearest well------------------------------ --------------------------------------- ❑ Distance to neatest lot line-------------------------------------------------- 4, ------------- y -„ � Remodeling and/or repairing,(describe)---------------- 4 -------- r -----------1 ---------------- -------------•---------- --------------------- - --------- -------------------------- ------------------------------------------------ I hereby certi=fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ` <, �er }er Contract k -_- �--- -- ---- -------- ------ -------- ---------------- (Signed) ----------- [ (Signed)- ------ - -------------- . ------------ - .. # —..�„------------------- ------- ------ -tTifla)�� '!i ' Y— — - -- [Plot plan, showing size of lot, location of syste in relation,to wells, buildings, etc.,,can be placed an reverse side). E FOR DEP RTMENT USE ONLY I -------------------- - DATE----- 4 �3- � ----------------- APPLICATION ACCEPTED B -- ------- --------- - --------- --- DATE_-------------------•-------- ------------------------- REVIEWED BY - - DA FE. BUILDINGPERMIT ISSUED---------=-=-------------------------- - --------------------------------•-------------------------- Alteratio s and/or recommendations: -- . b ---------- ---- 41 F _--__ _- _ -- �_�___ ___ ___ --124______ .___-.fy---------.------- --__.- ------ ----;.- ------------ --------------------------------------I-------------------------- ----------------- --------- --------------------- ----- - ----- / - ---------------------- ' -------------- FINAL INSPECTION BY - -- -------- - -------- ---------------- --- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 614 North "C" Street 340 West Oak Street 134 South American Street Manteca, California Tracy, California Stockton, California Lodi, California ES-9-2M Revised S-'59 F,P,Co.