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FOR OFFICE USE: e7j - APPLICATION FOR SANITATION PERMIT., Permit No. .'..`3.`.x...,7. 4 -------- ------- ------------------ ---------- ----- ------------ -------------------- ----------------------- (Complete in Duplicate) Date Issued 7 ._4 - ---------------- This Permit Expires I Year From Date�'Iisued --------------------- Application 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. 10 JOB ADDRESS AND_LQ�,ATION.........pnei�69__, .-....0/ -------------- ---------- lrvxl_� � 06- ---------------- Phone...' Owner's Name........ li4_5�7.1k/......... ---------4��_-1 _7 ---------------------------- _4�--- ................-11----------------............................ ................. Address------------- . Contractor's Name---- ------------- Phone,,� r�rl-----*e---5aeolt --- Motel [j Other El Installation will serve: Residence"V Apartment House 0 Commercial L] Trailer Court ❑ Number of living units: Number of bedrooms _;_", Number of baths _/--- Lot size ------ ------------------ - .1 151_1� Water Supply: Public systemCommunityComunity system El Private E] Depth to Water Table -------- Character of soil to a depth 23bet: Sand ❑ Gravel [] Sandy Loam [I Clay Loam [I Clay ❑ AdobeHardpan C] Previous Application Made:., (If yes,date------ ------------ No Now C6nstruction. Yes E] No C] FHA/VA: Yes ❑ No [I TYPE OF INSTALLATION 'AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) li Se%1.a ak: -_m Distance from nearest well-----------------Distance from folinclation--------------------Material------------------------------------------------- --------------------------------Liquid depth--------------------------Capacity-------------------- No. of compartments- Size D;spo I ield: Distance from nearest ---Distance from foundation.. .129- -.Distance to nearest lot line------------------ D tanc - -_Z------- 'Length of each r ---------------------- Number.of lines------?- ----------------------- line----_--- Width of trench---'- "e, �oy length____--- -- ------------------------- Type of filter material -'---Depth of filter material_ ---------Total lengt 14 11. - - Distance Seeea A/fl_ -0-------------Distance to nearest lot line-5---------- ,ge Pit; Distance to nearest�lll -_ 11/ Distan(f-e from founclafion--/ NNumber of pits----- f/---------,--Lining material-- Size: Diameter__,:!f -----------Depth-. ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation_- -----------7__Lining material------------------------------------- El Size: Diameter------- I--------------------- :--.,Depth--.-------------------------------------------- -----Liquid Capacity------------------------....gals. Privy- Distance,from est well-------------:----__-------_.---------- -- ---------Distance from nearest building------------ -------------_------------- Distance to nearest [of 1i7e----------- ----------------------------- --------------------------------------------------------------------------------------------- - ❑ d • Remodeling and/or repairi'ng (describe)--------------- - --------t--. -- ------------------------------------------ --------------- ----------------I--------------------------------- --------------- --------------- - ----------------- ----------------------------------------------------------- ---------- ------------- -------- ----------------Z_ ----------------------------------- ------------- ---------I hereby certify that I have prep64d'fhis application and that the'work will be done in accordance with San Joaquin County ordinances, State laws, and rules 6ncl ir�gulations of the San Joaquin Local Health District. • (Signed)---------=:)A--------- ------------------------(Owner a;d/or Contractor) By: ------------ ------------------------------------------- ------------------ ------------ ,-r f-, t 10) (Plot plan, showing size of lot, location of systemin relation ion to wells, buildings, etc., can be placed on reverse side). " FOR DEPARTMENT USE ONLY APPLICATION AC.- CEPTED BY------------- ------------------- ----�-- -------------------------------------- DATE -------- REVIEWED BY.....- - - .- ------- ------------------------------------------------ DATE---- ------------------ BUILDING PERMIT ISSUED--_----------------------*------------------------------------------------------- DATE-- Alterations and/or recommendations:- - - - - --- --- ------------------------------------------------------------------------------------------------------------------------------- - - ------------------------- -------I----------- -----------------------------------------------------_- ---------------- -- ---- ---------------•------..-..------------------------------------------------------- ------------------------ ---------------------------------------------------------- T---------- ----------------- _�1-77' ----- --------------------------------------------------------- -------------------------------- ------------------ --------------- ---------------------------------------- ---------------------------------- -- -----II 7 -------------------- ------------------I------------------------------------------------------------------------ ------------------------------------- ---------------------------------------------------------- ---------- p FINAL INSPECTION BY:..'--- --------------- -- Date- ------- ------------------------------- 4 SAN JOAQUIN LOCAL HEALTH DISTRICT fi 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Colifomia Tracy,California r9-9 FIEVIBED 0-59 F.R.CD.ZM 6-6P