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' ' APPLICAT(ON FOR SANITATION PERMIT Permit lyo. ,c_._�..�_-- . (/ (Complete in Duplicate) Date Issued -----61-IL Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ' This application is made in compliance with County Ordinance No. 549. - '__ --------- - �'1/ e /' � ' iL ,-- ------•----=------------- JOB ADDRESS AND LOCATION Owners Name__ _ _ ___ . . ___ _ -- , �^ ....... Phone_-----_ �� Address-----------f�.af _ h. ------- Y -- _ c.U- ------ �. f/ •------ -------------------- Contractor's Phone-- ,j� w Name____ t Motel ❑ Other Installation will serve: Residence [] par#ment House ❑ Commercial Trailer Court ❑ ❑ ° __._ Number of baths ._�__ Lot size __�--�-�-`----��- -��-�----------------- # Number of living units: __/_._ Number of bedrooms + Water Supply: Public system ommunity system [IPrivate ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam ❑ Clay Loam [IClay E] Adobe Hardpan Q f Previous Application Made: Yes [I TYPE ew Construction: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 20d feet.(/ f Distance from nearest well_I"!��-__Distance f�f m foundation_-�Q____.__._.Material________________________ __K-.----- Septic Ta - No. of comport rents 5'sze., � -- -- •---Liquid depth r Capacity... t ri Disposal Fie d: Distance from neo well_ t7t Q,. =Distanceirom founclati 0_-P_..---.---Distance to nearest lot line___._...___. Len th of each line___ + - .-- ------Width of trench_.c___ '`f--------------- Number of lines_.- ----------- --- - 9 /i i Type of filter material.��c--�-3--Depth of filter materiaL______�_�____..Total length-----�s.��------------------•-- Seepage Pit: Distance to nearest well-------_--------------Distance from foundation.___.... __.Distance to nearest lot line____________.____ Number of pits-----------------------Lining material-------------- --------Size: Diameter-----------------------Depth.-------------------------------- Cesspool-, Distance from nearest well_________________Distance from foundation-__.-.______.__.-._.Lining material---------------------------------------- � ----Depth----•------------------------- - -------------------Liquid Capacity...-. 981s. ❑ Size: Diameter------------------------------ - -- Privy: Distance from nearest well _.__.-------- ----------------------------------Distance from nearest building------------------------------- ------ - ------------------ -----•-- ------ El Distance to nearest lot ine______________________________�._____...- Remodeling and/or repairing (describe):------------------------------------- ----------•------ -- -•--------••------••--------------•--•-----------------••------ I ____________________________________---------------------------------- __-_. E ________________________________________________________•-______________.-__._.------------.------------------------------------- f ----•--------•---------------------------------•---- { = -------- 4 - - ------ --- --- - ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DAY &NIGHT _4 - Septi _Tn_nk_Service ---------------------- /� , -- -- (O nd or Contractor) Signed) ------ - _caner a ( g } 120G So. Eldarado 1H0 2-7046 I 8y:__...__le - .------ ------------- ----- -- -- -- - �t f_ (Title)---- -� Y (Plot plan, showing size of lot, location o? system in relation to welt, buildings, etc., an be placed on reverse side(. FOR DEPARTMENT USE ONLY 64— r APPLICATION ACCEPTED BY .• DATE?----------------- --------------------------------- REVIEWED BY '. DATE__�..----------•------------------------------------- BUILDING•PERMIT ISSUED_________________________________ = DATE.. ;— ----------------------------------------•- Alterations and/or recommendatio ns------------------------------------ ------ ------------------------------------ -------------------------------- ------------------------------------------------------ FINAL INSPECTION BY------- ---------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street l30 South American Street � Tree California Stockton, California Lodi, California Manteca, California y E 5-9 145446-AT WC C D