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FOR OFFICE USE; a /U• Permit No. .. ---•--- .. -- -----------� :_�--�_ ---- - APPLICATION FOR `SANITATION PERMIT ---- ----- -- - (Complete-in Duplicate) Date Issued - ------ ------------ -- This Permit Expires 1 Year From Date Issued Application is hereby made to the Sar,Joaquin Local Health DiNoc fora permit to construct and install the work herein described. in complianceI with County C_ 49. This application is made -------------------------- - JOB ADDRESS AND- LO ATION--- -- hone------------------------------ -------------------- P Owner's Nam ��` -------- -- ------ ------------ r - �-•- I Address ------------------------ • �Lu� Phone_. - -------------- Contractor's Name.................... r Motel ❑ Other Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ X Number of living units: - .- Number of bedrooms 3_. Number of baths-_.-... Lot size .......- Z5 '�� t Private ��,,,,��epth to Water Table T. _ ft RrWater Supply.• Public system ❑ Community system ❑'�,� �a Adobe [Hardpan ❑ t Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 fee+• Sand ❑ Gravel ❑ Sandy Loam ❑' y Previous Application'Made: {If yes,date_-------------- - - I No ❑ New Construction: Yes ❑ No �HA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND'SPECIFICATIONS: (No septic tank or cesspool perrititted if public sewer is available within 200 feet.) I 9S�epttTank: Distance from {.Weil-----------------Dliisttance from foundati quid depth Materia4 Capacity---------------- ------ I No. of compartmentsr *� . k l -------Distance to nearest lot li�e __l ""' Disposal geld: Distance from nearest welL.Jf Z_......-.Distance from foundation. �0-- ----- ---------Width of trent -. ❑/ Number of lines--.-_ ----- Length of each Ike_- �� r- Q i�. C/�Depth of filter mater al--- --------- Total le�gth_-------------------- ---- { Type of filter material...-; 1 .5 �nce to nearest lot line.l�.�-.---•'�`� Seepage:Pit: Distance to nearest well. eo"- ----Distancem f undation.--� Size: Diameter.. Depth '`� ` Linin material..._-- " ` Number of pits.._- --------- 5 Distance fi•omnearest well _...-_.._..._.-Distance from foundation.....__..._..__. ..Lining material---------------------------------•--- 1 Cesspool: _----Li Liquid Capacity----------------------------gals. ❑ Size: Diameter ---------- --- --- -------Depth.--------- ---- --------------- q p Y __Distance from nearest building Privy: Distance from nearest well.--;-------------- ----- ----------- ❑ Distance to nearest lot line ------------- ---- -------------------------------- r. --------------------------------- Remodeling and/or repairing (descir be�:___......___._--- t - ---------------- j -------•-------------------------------------- --_------------------- [ ------- - -------------------------- j I hereby certify that l .have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S 'te laws, and rules an regal tions:of the San-Joaq in Local Health district. _.._.(O ner and/or Contractor] (Signed)--- - ------ - -- --- --- - - ---- --- -- • -------------- (Signed) ---- ------ ---- - -------- By --- -------- - -- ..--- i Title. -- - ----- (Plot plan, showing size of lot, location o system in relat' n to wells, buildings, etc., can be p aced on reverse side). FOR DEPARTMENT USE ONLY - " ------ DATE--------- �� y - ---------- APPLICATION ACCEPTED DATE--------'----------•----•------------- ------------------ -- REVIEWED BY------------------------------------- ------ -------- - ----- lBUILDING PERMIT ISSUED-------- -- ---------- ------------------- --------- --------—--------------------- ------------' --------- ---------- Alterations and/or recommendations:..................... ------------------------- ----------------------- ------- ---- ------------- --------------------------------- Date------ --1.-�.~ly`2,.. �� /---------- ------ ----- Y FINAL INSPECTION BY:..._._.- -- F --- � -- �-- - I SAN JOAQUIN LOCAL HEALTH DISTRICT ' 300 West Oak Street 124 Sycamore Street 205 West 91h Street 1601 E.140jelton Ave. Tracy,California I Lodi, California Manteca,California Stockton,California E.H.9 2M 1.67 Vanguard Press