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r �y� APPLICATION FOR SANITATION PERMIT Permit c" fay' (Complete in:Duplicate) Date Issued a/-5 -� Application is hereby Imade�to the San Joaquin Local Health'District for a permit to-construct and install the work herein described. 'in compfiance with County Ordinanlce.No. 549. This application is made - 2 ----------------------------- = " JOB ADDRESS AN CATION_" - t�--- - ++ /-fir` 7 Phone---- - . y 1 Pho Owners Name---------- j �- r / ...------------------- Address - ---- Address----------A � � Phone Contractors will !- ----:--- - - ---------------------- ---------=--- ------------ --------------- one_. f Commercial Trailer Court Motel ❑. Other ❑ # Installation will serve: Residenc Apartment House ❑. ❑ 7 IF i - - u - Nurimber of living units: , Dumber of bedrooms Number of baths _ � s1� _ t __ Lot size -___ P Water Supply: Publicsystem Commun'ity�system',❑ Private Qe th to Water 71 -' \\ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑4C Sandy Loam ❑ Clay Loam [I Clay ❑ Adob `Hardpan [I Previous ApplicationIMade: Yeas ❑ iVd New Construction'. Yes No FHA/VA: Yes ❑ No ❑ I i ; k ...r ..� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer; s available within 200 feet.) . .... .. P_....,w . Material- ' Septi Tank: Distance from nearest well-________-_____I DiMance fro oun anon__ - Capacity_.__ No. of compartments--'- -----------------Size , , ( ----Liquid depth--:-- --- t ! r � _._.Distance to nearest lot line Disposal Pield: T Distance from nearest well_ --.__.Q stance from founds ion-3 `�,oWidth of trench.__ \1 Nu-mber of,lines__ - Length of each lines /=�- t rV Type of filter material:_____ - - __ Depth of filter material___ - --:-�----Total. length____ C --------------' _ W yt ., rial__ to.nearest lot line__._S ---. isre _____Dstance4 a a " stell-._-S Diam ____ ---Depth-----2_ .••Number of p Lining , d 1 ql C.. ' . . Cesspool: ?"" Distance fi-6m": .nearest well---__:__._____:Distance fro foundation....-._.______._--.Lining materia l________________________:._______._. ► - Dle th--- - -=------- -- =- 3 = Liquid Capacity ' --------------------------gals. ------ Al Size: Dia f eter4: . ' ipp t } 1 4-'''Distance from'nearest well-_° ! qh------------ -- ---- Distance from nearest building.-`-- Privy: --- --- _ J� - - ----- - ❑ __"` ��~~^y"Qistance-to nearest`:lotiline�� :__ ------ ----:- ----- ------ -: ' } y M --- ------ -rr��+ ------------ R -------- - : �_" Re odeling repairing (describe): ' ' -•--------------------- ------ r : - - k - - ' ---------- ----- _ __ ---- --- ---------------- -- 4 i _ _____ _____________ a ( --------------------------------------... _.___.____"____._____ ....._ -- --- ----- --- ---------------------- Q,( J I hereby certify that I have prepared this appLcation�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. laOwner and/or C A , f `_"_-_� __�_.-----------____'_______________( ontractorl I [Signed) ----- 1. t a i .-~ = itle) = I --'� =:--•- By=-- (Plot plan, showing size of lot, location of system in relati n to wells, buildings, etc., can be placed Fon reverse side]. FOR DEPARTMENT USE ONLY ,o- I =----- DATE_._--------- - {--- ----------- ------ --------- APPLICATION ACCEPTED BY--'--------------------- - - '- -- E - = = -------=---------- ' REVIEWED BY------------ ��_1 "I'= ' DATE = BUILDING PERMIT ISSUED----- `�----'=--- - , ,. : � --.------ ----'--, --------y--;----� ,------- ---_-----_ ._ - DATE t = • ... -------------•----------- ------ ---------------------------- Alterations -_----- Alterations and/or recammert�dado s: ---'_----- - ._---- } ---------------- --- - ------- -------------- ------------------ - �- r ----------------- ------ ----------- ----------------- ---- r t sM --- ----------------- - ; ------"-- •------------ -- V -- - - --------- -------- --_-------- --- -_ ---- -- ---- -- - ....�,. FINAL INSPECTION BY _ : I d r M SAN JOAQUlIN LOCAL HEALTH DISTRICT ! I 814 North "C" Straet ff camore Street 130 South.All in Street 300 West Oak Street 132 5 Y SManteca, California Tracy, California Stockton, California Lodi, California I 1 ES-L9-2M Revised 1.57 F.P.CO.