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.- .. �. C Permit No. 5 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued 6� 3 A licatian is hereby made to the San#Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-..__._ -- hone.-__".-_-_____"._------•-----" --------------- .........--- Owner's Name---------=----:��--b"l" --------------------- f -------- Address--------------- --Address-•-------------•1 _ / Phone--�-- --- ------------- s Name-.__Contractor' d'----Q Ous Motel ❑ Other ❑ Commerci Trailer Court ❑ Installation wily serve: Residence Apartment House ❑ tv- �_ •Number of baths _�----- Lot size` Number of living units: --�--- Number of bedrooms Private ❑. Depth to Water Table-- ft• Water Supply: Publics system system ❑ Clay Adobe Hardpan ❑ pP Y� Yoam Loam ❑ Y ❑ Character of soil to a depth of 3 feet:. Sand New Conravelstr❑uction Yes pq ❑No ❑ Previous Application Made: Yes 0 N TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted�if public sewer is available within 200 feet.) Liquid depth Capacity 3 Septic Tank: Distance from nearest well----------------- I from foun anon_--_--.-____ -------------------- ------------------------------------------------- Septic ------ ------ ------ -------- i., ' No. of compartments---------- -- -----5 ------•---- -_- istance from foundation"- - U n.._".Distance to nearest lot�ne_fl --•--- Field: Distance from nearst wel Disp �-- .........-Width of french----- ------------------------ Ilines—b-'+ . ength of each line"__-__ Number of - ------ -- - _ -!--Total length ----- ---------•----------------�-� - Type ar' filter material±_ - _ _ epth of filter material-__--�-- --- ,`}�----.Di tante to nearest lot line--- - --- Seepage Pit:. Distance to nearest wellll�r.�Y_--- Distance from�fou Sile:nDiameter---- - Depth-_-. Number of pits.- _ "_---- _ Lining material_ els. Cesspool: Distance from nearest well-_----_"-__--____Distance from fo --- Lining materia------------------------------------- .De th _ - -- -- L!�iwd Capacity _ ---------{, 9 ti Size: Diameter---- -- - - ---- — p _- _ - ❑ Distance from nearest building Distance from nearest well------------------- - ---------------------.--------------------- ------------- � Fest lot ine------------------------------- --------- - --- ------ -------------------- ---- ` Distance to near -------- - -- Remodeling and/or repairing (describe):-_----_ .- _ ----- -- -- !b ; --- --- ----- - ------ - - ------------- - ---------------------------------------- I hereby certify that I have penty pr regthis ap ulations ns off th�oSan Joaquin Local kHeal Health t, accordance with an JoaquinCo ordinances, State laws, and rulesg (Own dor Qbntractor --A ------------------------ -- --------- (Signed) -(Title) By------------------ r ---"------• (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 4�2 -----------------------------------------•------•----------•------------- DATE �----------- ---- ------------------------------------ APPLICATION ACCEPTED BY-_�_-----------" - - --------------------•-----•---__-- DATE----�--'--------:--•----------------------•---------- - REVIEWEDBY-------------------------------- °-------------------- - ---------------------------------------------I----- ------------ ---••--- - -----------------------------•------------ ------------- - D --------- -- - BUILDING PERMIT ISSUED-------'-•--------------- ----------------------- --------- -------------------- Alterations and/or recommendations:.".-----"-- __ ___________________________ -------•-----• --• ---- ------- ----•-- -------------------------- ---------- --- ------- a Date_". -5 FINAL INSPECTION B : --- ---- "--- -------------------- --------------------- .--_--:`. -- ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street Sycamore Street 300 West Oak Street 132 SyTracy, California 130 South American Sires# Man+eta, California Stockton, California Lodi, California ES-4-2M 10-52 Revised W-2100 _