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12 Permit No. APPLI-CATION FOR SANITATION PERMIT --------- (Complete in Duplicate) Date Issued d install the work herein describeJ I Health District for a qe7�i to construct an licat.ion is hereby made to the San Joaquin Loca '. 549. made in compliance with County Ordinance Nc T,�Tappiication is rn -------- ------- ---------------- ----- -------------------------------- JOB ADDRESS AND LOCATPN_---- ---- Phone X(" -------:-------- -------- --------- 7-/- ---------- -------- - - - ----- ---- ------------------ ---------------- Owner's NamA- d------------------------------------------- --;-- ------------------------------------------------------------ Address--- ------------------------ Phone ----- --- -- --- -------------------------------------------------------------------- - -------- Other 0 Contri)ctor's Name____________ Motel ❑ Apartment House 0 Comrnerc!41 C1 Trailer Court 0 Installation will serve: Resiclence-�d .......7a- e5 -------------- Number of living units' Number of bedrooms ____f- Number of baths I--- Lot size ---/ - ----- Number ---- ;?--------- ; system Community 5Y,trn [] Private 0 Depth to Water TableJA. Hardpan 0 Water Supply: Public A Gravel ❑[I Sandy Loam 0 Clay Loam El Clay 0 Ado6e�< Character of soil to a depth of 3 feet: Sand 0 Ej�,e No ❑ FHA/VA: Yes ❑ No�K.1 Previodi Application Made: Yes El Nd,-Q� 'New Construction: Ye?- ---- . Ej i TYPE OF INSTALLATION AND SPECIFICATIONS: available within 2 (No septic tank ar'cesspool Per�nitted if public sewer is erial---- --------- W�e well 00 at -r- Li t C, 8pacity------?3 Z, Distance from foundati Septic Tank-. Distance from nearest e-I------ ---- Size--No. of compartments---- earest lot line---------------------- ,�o I aresf well. -stance from founddfion--------------------Distance to n Disposal Held- Distance from nearest --------Di ----------Widf� of frencIn----------------- ------------ Number of lines------------------------------------Length of each line-------------------- length------------------------------------------ El Type of filter material-------------------------Depth of filter material----------------------.Total ---------------- T It rest well---------------m------Distance from found6tion--------------------Distance to nearest Iot line ....... ...... Distance to nen ---------------- -----.Depth------------- Seepage Pit: Number of pits-----------------------Lining material-----------------------S�ze: Diameter- 0 Distance from I nearest well-----------------Distance from foundation--------------------Lining material_----------------------- 4 - --------------------------- ------- Cesspool: ---------Depth----------------------------------------------------Liquid Capacity-----------------------------gail�) F1 Size: Diameter:----------------------- Distance iameter:------------------------ is�ance from nearest building------------------------------ ---------- Privy: Distance.1'rom nearest well--------------------------------------- ---------Distance —--------- —------------------------- --------------------------- ---------------------------------------- -------- -- --- ----- - ---- ------------ Distance to nearest lot line------------------- ------------/ F1 ----er;-Z-/------------------ nd/or repairing (des I -------- - --- ------ --------------------------- Remod�el' . - ----- --------------I----------------------------- -------------------- -------------7---------------------------------------- ------- ------------------------------------------ - ---- - ---------------------------- ----------- ------------------------------------------------------- ----------------------------------- ---------- ............ -------------------------- -------------------------------- -------------------------- --- ------- ----------------------- - ------------------------------------------------------------------------ I hereby certify that I have prepared------------------------------------------------------------------------------------------------------------with San Joaquin County J that e work wibe done iaccordance w is application an; ordinances. Stale laws, and rules and reg anions of the San Joaquithn Local Heall lth District.n Contraetot) n-r a Or w ' __ . -a or --------------------------- -.(Owner --------------------------- ------------------ ---------- '--- -- ------- --------- -(Tif le) ----------- --- ----- --- --------------------------------------------------- ", s ------------------- Uike;l��on reverse side. BY:---------- location of system in relation to wells, buildings, etc., can 6a p (plot plan, showiesilze Of lot- 1 FOR DEPARTMENT USE ONLY ' - --------- - - --- -- ------- ---------- ---------- --------------- - -- ---------------------------- ------------------ DATE------- -------------- APPLICATION ACCEPTED BY--- ----- DATE- ---- -- --------- -- ----- - REVIEWEDBy-------------------------- ---------------- --- -- - -- - - ---------------------- I---------------------------------------------------------- ------ - --------------------------------- BUILDING PERMIT ISSUED------ ------a--- ----------------------------------- --------- -------- - ---------- Alterations -------Alterations----a----n----d--/or recommendations:-______.------I -- --------- --_________________•---.---------------- ---------- ----- -------------- --------------------------------------------- ------- --------------------------------------------------------- ---------- ----- -------------- ---------------------- - ----i---------------------------------- ------------ ----------------------------------I--------------------------------- -------------------------------------------------------I--------------------- ------------------------------------------------------------------------ ---- ---------- --------------------------------------------I-------- --------------------------------- ----- ------------------------------------ --------------- ------ ------ --------- --------------------------- FINAL INSPECTION BY:------�1- ---------------x--------------------- Date---------- ---- --- ------- --- --- - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West oak Street Manteca, California Tracy, California Lodi, California Stockton, California Revisea 1.57 F.?-CO-