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I f �� Permit No. _--�--41'-6 W APPLICATION FOR SANITATION PERMIT / (Complete in Duplicated Date Issued !-1• � v •.,. - s "° This Permit Ex ires 1 Year From Date Issued j 3— 'FO_t C�' ;W::�►�'t X4-'17 e,E�s permit to construct and in I }h wcvherein described. P J Application'is hereby made to the San Joaquin Local Health District for p This application is made in complian a with County Ordinance No. 549. ------------- ----- --- ---- JOB ADDRESS LOCATI N ---- ---------------- --- Phone__._7f1. Owner's Na e -- --- ------- -- �-• --- --- ---- ---- -- : Address---------- ------ Phone-11 --------/�� 4 -- ------ ------ Contractor's Name__ Motel ❑ Other Apartment House ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence ❑ Ap w� <"` ---------------------- Number of living units: Number of bedrooms `..--Number of bats _ t sae ------- ---- ----- Communit s stem ❑ Private Depth to Water Table -------- ft. Water Supply: Public system ElY Y y ❑ Adobe❑ Hardpan ❑ , Character of soil to a depth of 3 feet: ; Sand C] Gravel [3 Sandy Loam lay Loam ❑ Clay Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.] ��-------Material------------------------ Sep-tic -�------------------- • �.�: Liquid depth-------��- -----Capacity----- aR , Sep-tic Tank: Distance from nearest well/e_Q----Distance from foun at+an___ __ No. of compartments___ Size__-- /�______--Distance to nearest lot line_________________ Disposal FJ Id: Distance from nearest well-/ from Distance f�m foundation.__-____i -_ V Number of lines__- -- Length of each line Q ----------Width of trench----' ��'�� Depth of filter material-------l_c�-�I- Total Isngth_--______CZ-0----------•--- Type of filter material- --- p 5eepage Pit: Distance to nearest well_____________________Distance from foundation--------------------Distance to nearest lot ine---------------•- Number of pits e - Lining material---------- ------------Size: Diameter.----------------------Depth--------------------------------�J"`� ❑ Distance from nearest well-----------------Distance from foundation--.__._.-----------.fining material__._____---------- -------els. Cesspool: ---De Depth ------ ----------------------------------------- 0 ----------------- ------ ------------- Liquid CapacifiY------------------ -------•-9 ❑ Size: Diameter-------------------------------- p % Distance from nearest,well_-___- Distance from nearest building------------------------------------.----- .�-J --Privy: ------------------------------- -------- ❑ Distance to nearest lot ine___------------------ -------------- Remodeling and/or repairing (describe -------------------'--------------------------- ------- ----•------- ----•----------------------------=-- ------ -------------- ---------------------------------------------------- k ------------------------------•-------------------------------------- - q ----------- ------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc , a laws, and rules an regulations of the San Joaquin Local Health District. -----__ (Owner nd/or Contractor] -------- ------ ------- ,' s (Signed) - ---------------------(Title] ------------------------ ------------- ------ - -- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -- DATE q -------------------- - ---------- - APPLICATION ACCEPTED BY DATE__ --------------- ----- ----- ------- ------------- REVIEWED BY-------- ---- ------- -------------------------- DA BUILDINGPERMIT ISSUED---------------------------------------------------•---------- ---------------- - --------------------------------------------------------•----= -------------------- --------------------------------------------------- Alterations and/or recommendations:__--`---------------- ________.___..----------- ------------------------------------------------ ------------------------ ---------- ------------------------------------- ---------------- ------- ---- a --•------------------- ---------- Date--------------(� --------------------- FINAL INSPECTION BY:___!_-.-_ .-- - -�'•='--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 300 West Oak Street 132 Sycamore Street 130 South American Street Lodi, California Manteca, California Tracy, California Stockton, California ES-9-2M' Revised 8-'59 _i ..