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Permit No. FOR SANITATION PERMIT ---- (Complete in Duplicate) Date Issued --- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 'C u e N67549. This application is made in compliance wAithC u t ------------ - ----- --------------------------- ----- JOB ADDRESS AND LInCIN----------- - -- ----- --------- --- -- - ------ r q� 'a Phone_----------------------------------- -----------------7------------------------------ ------------------------------------ Owner's Name------------------ 10 Address----------_-----•----•--------- _-iyt- - - - ------- ..1------ --------------------------- Contractor's Name-..-'- ------ --------------------------------------------------------Motel C] Other D Phone.4-i9----------------7--------- Installation will serve: Residence Apartment House F1 Commercial 0 Trailer Court []&-d / �7w I :' rooms .2--_ -Number of baths /---- Lot size --- - -----e7--61------------------------- Number of living units -)---- Number of-bed" Water Supply: Public system olmu'nity system D Private El Depth to Water Table ;__ ft. A l Q.A�ardpa, 0 Character of soil to a depth of 3 feet: Sand E] Gravel M Sandy Loam 0 C1��y Loam 0 Clay [] Adobe' Previous Application Made: Yes 0 1 No 9--�New.Consfruction: Yes E4,-110 0 FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or'cesspool permitted if p(iblic sewer is available within 200 feet.) ,10, 01 Material--- Se Distance from nearest well--5 10 Distance from found gfion-_45�--------- No. of c;ompartments..__'2---—-------------Size___,6- 1.,6,' Septic Liquid depth--- -----Capacity----------- Mstance from n; _- _Distance from found nearest well afion_ _�-----Distance to nearest lot ling si�----------- Di sy Disposal Number of lines!____----?-------------------Length_of_eachline------SS--0-------I-e--_.Width of trench----------------i------------------ Type of filter material—_--—C. Depth of filter material------/4------------Total'.length---------1�0------------------- -- Seepage Pit: Distance to nearest well______________" ------Distance from foundation-------------------Distance to nearest lot line___-___`_---___-_ F-1 Number of pits------.---------------Lining material---------- ----------- Size: Diameter-----------------------Deptn-----------------------:---------- Cesspool Distance from nearest well------------------Distance from foundation__-__-_______------Lining material__--___--_-------------- I----------- -------Depth---------------------------------------------------------- ------------------------------------Liquid Capacity----------------- ----------g als- 171 Size: Diameter-- ------------------- I II ------- Privy-. Distance from nearest well--___--._---- ----------------------------------Distance from nearest building-___------------------------------ ❑ Distance to nearest lot line--------------`--------- - ----------------------- ----------------------------------------------------- �Ze------------- - -------------- ---------------------- Remodeling and/or repairing (clescrilSe):-----------------I--------�_ IIL ---------------------------------I------------------------------------------ --------------------- -------------------------------I--------------------- -------------------------------- ff I ---------- ----------V--------- I*. L__� - ------------------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------------------------4W--------------- ---------- ---------------------------- --------------I----------------------- ------------------- -----------------:-------I------------------------__---•------------------------------------------ I ------------------------------------------------- tY' ----------------------------------- In I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and rules and,regulati s.of t�e San Joaquin.�.Loc_Waal D1 'kct. /, w, ---- - - ----------- ____{Owner and/or-dontractorl ---- --------- ------ (Signed')------------------ - - ---- ---- - ---------- - - --- - -----------------------------------------------------------------(Title)-- -------- --------------------------- By:_------- --- -------------------------------------------------- reverse side). (Plot plan, sho j 9 Size Of lot, location of system in relation to wells, buildings, efc., can be placed on FOR DEPARTMENT USE ONLY DATE-- 7 y/ APPLICATION ACCEPTED BY------------- -------------- ------/__ --- ----------------------------------------------------- ----- -- -- -------- REVIEWEDBY------------------------------------------------------- 0- -—- -------------------------------------------- DATE BUILDINGPERMIT ISSUED----------------------------------)a--------------------------------------------------------------- DATE------------------------------------------------------------- Alferlations. and/or recommendations----------------------------- ----•-------------"--------•-- -------- ------------- -------------------------------- -------------------------------------------------- ----------------------- --------- --- -----------------------------! -- ---------- -------------------------------------------------------------------------------------------------------------- - -------------------------------- --- ----------------- -------91z---.-:t ---------------------- ---------------------------------------------------------------------------------------- ---------- ------- ------------------ - --------------- --------------------------------------------------------- i- ------------------------------------------ --------------------------------------- ------------ ---------------------------------------------- _"'^ -------------------------------------DV _--------------- -- ----- -- ------------------------------------ FINAL INSPECTION-RY-------------- ----------------------- SAN JOAQUIN LOCAL'HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Manteca, California Tracy, California Stockton, California Lodi, California ES-4-2M Revised 1.57 F.P.00.