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FOROFFICE USE: z ; ---------------------------------------------------- --- r -------------------------------- ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. __-/--7L2.?--_ , ----------------- ----------------------------- ---- (Complete in Duplica+e) �� -------- --- This Permit Expires 1 Year From Date tissued Date Issued !-,� t 0 Application is hereby made to the San Joaquin Local Health District for a permit to construct nd install the work herein descr ed. I {'�Thls_application,.is,made,.in compliance with County Ordinance No. 549. d. JOB ADDRESS AND LOCATION- _ �"" .:�fi. ----- - � 4 E Owner's Nam r - --- ------------•----••---•-------- - ---- - ----- ------------ Phone----••--------------. .. - - Address 4 alb --- Contractor's Name l- -••-- __ --- Phone ; -- ❑-------- -------------------❑-- Motel Installation will serve- Residence Apartment House ❑ Commercial Trailer Court �i ❑ Other ❑ F Number,of living units J---- Number of bedrooms _ ' Number o baths ----1_ Lot size ______ -- - -----------------_----___----_____ Water Supply: Pblics ppy� ua ystem ❑ Community system ❑ Private RT Depth t Ater Table -------- ft. - Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Clay-Loam ❑ Clay ❑ Adobe'❑ Hardpan ❑ Previous Application Made: (If yes,date-----------,--------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: h.(No septic tank or cesspool permitted if_public sewer is available within 200 feet.) Septi ank: Distance from nearest weil---- -`�-Distance from foundation------1_T_____.Material____________ _________.______--______-- _._.__No. of compartments___--- y. s_ ---------Liquid depth------- -----------Capaci Disposa =ield: Distance from nearest well----- ._l, Distance from foundation_____—D-------_•Distance to nearest lot line _ Number of lines 2-- .�!?_ -_- Length of each line-______ _i - ..__.. -_._-____._.Width of trench.____._ � 4 -yr-------------------- r Type of filter materiaih___. Depth of filter material__-____« Totald. ------ r - --- --- ------�-�----------------------- Seeps Pif: Distance to nearest well /----Distance .fr mkundafion-_/A__ ..___._.Distance to nearest lot Iine__rr__----.._Number of pits__.__. � _-_-_Lining material--A -_.Size: Diameter----- ��_---Depth___-.--" _rS" _ ---- Cesspool: Distance .from nearest well-----------------Distance from foundation.__-_.--------------Lining material------------------- -_____-__,_ ❑ Size: Diameter------------------------------------- Depth-------------------•--------------- ----- Liquid Capacity --------gals. 'i Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildingU ❑.. Distance to nearest lot line----------------- P Remodeling and/or repairing {describe]=------------------------------------------------------------------------ -> ---------------------------------------------------------------------- - i --------------------------------------------------------------------- -----------------------•------ --------------------------------------.----=------------------- -------------------------•------------------------- q y ' I hereby certify th I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la d rules and regulations of the San Joaquin Local Health District. (Signed)--------------- f w / Contractor) ---- ------- ----------- ------------------------- ------- an r By:--------- --IL ---- - - r--------- --- 1 f r d ,. - --- -----------------------------��--(Title)------- .----_---/--------- ---------0 .......... 3 l'lof'Ian, show "!` e { p g size of lo+, location of system relation +' wells;.buildings; etc.,,can be:placed`on reve"rse'sid'e].��"�- — FOR DEPARTMENT USE ONLY r -' APPLICATION ACCEPTEDBY_. ---------------- DATE = ~lO ----- - ----- ---- REVIEWED BY-------------------------------------------------------------------------------------------------------------------------._._ DATE----- -----•------'---------------------- --------- - --- BUILDING PERMIT ISSUED_____________ _ , ' Alterations and/or recommendations:______________________ -- -------------------- --------------------------------------------------..--- - , •------------------------------- --------- --------- ---------------------------- FINAL INSPECTION BY,'"' i7n .f-f --- ------------ Date_ .-. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street L Stockton,California Lodi,California Manteca,California Tracy,California B-59 am 3-163 F.P.CG�, ��-0��;.�,,, " � fir;•-�,f /!