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I,n APPLICATION FOR SANITATION--PERMIT Permit No. -......-�-�....- ` 00 k I �1 (Complete in Duplicate) Date Issued Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install thework herein described. This application is made in compliance with County Ordinance No. 549. 0'77- 330-09 "'01- tiC 4D s�-t1,E, p------ , JOB"ADDRESS`AND LOCATION,_ -- ---- - _-L1' ..1 - Phone I Owner's Nam - 1 1 _-cY`._�----------•----• (/" one Address. * i Contractor's Name �"��" -y -__---- Motel Other 7. Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ ❑ !Number of baths ---.' Lot size -- -¢--- -�-�Z ------------------------- Number of living units: _/----- Number of bedrooms __-2--Number Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table __20 ft. '•: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I_ Hardpan ❑ Previous Application Made: Yes ❑ No M_ New Construction: Yes.ig No ❑ TYPE OF IN AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,g tJ ---Distance from foundatio--:--16----------Material_-C� . '`--=^--- ---------- Septic Tank: Distance from nearest well------ ----_ - _ No. of compartments..____ Size__--��-.�J-Z---L•squid depth_ ---�a-Q.-.--------Capacity._--1o�-G �---- 5a _ -`-----E- t r Disposal Field: Distance from nearest well....- 4r.--___Distance from foundation-----ZD- .--.--.Distance to nearest lot line-_010 -� Number of lines- _- __.-.-_Length of each line--__-------'Jl2-11DWidth of trench----- -_---! N i� Total length -� ----------------- S(� Depth of filter material-.-_�--� 9 - Type of filter material-JA- -__-.--r -- -- p rest well.....-_--------------Distance from foundation---. Seepage Pit: Distance to nea ----- ---__-_.:Distance to nearest lot line----------------- ❑ Number of pits------------- ------Lining material----------.------------Size: Diameter------------.---------- Depth Cesspool: Distance from nearest well-----------------Distance from foundation---------.--------- Lining material---_--------------------------gals. ❑ -Liquid Capacity-- ----------------------- Size: Diameter------ ----------- --------- --------Depth--------------------------------- -------- ---- g Priv Distance from nearest well- ----------------Distance from nearest building------------------------------------------ ---------------------------------------------- ❑ Distance to nearest lot line------------------------ ------------------------------------ ------ Remodeling and/or repairing (describe)-------------------- -------------- -----•--------------------------•-----• -- prepared sthe San Joaquin Local Health Dist her eb certif that I have re ared this application oand that the work will be do in --cco-------------------------------------------------------- ----- anui -- ------ - -------------------------------------------------------------- - - - --- done in accordance with San Joaquin County Y Y District, ordinances, State laws, and/t,19and regulations q (Signed) ~ -----------------------------------------------------------_(Owner and/or Contractor) -------- -- - - - (Title) (Plot plan,isowl/ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------ DATE=-------------------------------------------------- REVIEWED BY----------------- ----------- --- -- ------------- -- -- ------------ DATE BUILDING PERMIT ISSUED-------------------------------- -- ---------------- DATE Alterations and/or recommendations---------------------- ----------- ------------ -------•------ •------=------------------= - ----------------------------- -------------------------------------- ----•--.......- . f ------------------••---- FINAL' INSPECTION BY:.._------ ---- .� �••�--'�----� Date----- ------- ------ - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y� ES-9-2M 145446 ATWOOD lz- ._