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7 -,t No. APPLICATION FOR SANITATION PERMIT , : letf (Complete in Duplicate). Date Issued -- --- , 5 Joa vin Local Health District for a permit to corns}rucfi.:ancl_instal?th��rh�ain descri e . Lica}ion is hereby.made to the San a /In �} ' 'on is made in compliance with County Ordinance No. 549. APP application = This app ---'�- � = r —__ ql `' � l n - � - -- --•--- Phone------- --- -�-- ----------- --------------- :a '--------- , JOB ADDRI5S AND LOCATION , .�-.P- -------- - -------------- ----- - ---------- - Owner's Name-----------•-----•-•- •--------------•-•-------- Phone----------------------------------- ---------------- 1 Address. ---------------------- -------------- �� Motel ❑ Other ❑ s Contractor's Name----------------------------- Commercial ❑ Trailer Court Residence Apartment House ❑ _ Installation will serve: _ Number of baths -----L Lot size -----• Depth`to Water Table .-. ft.. ~` -Number of living units: -------- umber of bedrooms - Private pdobe� Hardpan ❑ Water"Supply: Public system ❑ Community system ❑ Gravel ❑ Sandy Loam❑ Clay Loam Q 'Clay,❑ s Character of soil to a depth of 3 feet: Sand ❑New Construction: Yes No ❑ t 1 Application Made: Yes ❑ No Previous App � - " public sewer is available within 200 feet-1 •- .- _,._ s TYPE OF INSTALLATION AND SP eCmFtted if p S• - (No septic tank or cesspool'pe 1 a? capacity M b Disfian e from foundation MaterraL--------=- Li uid depth-_ ' ----- .-.--� a, Septic Tank: Distance from nearest well.-_-_��-_---- rj/ � � q Size--/-..-_._--._ --�____.Distance to nearest lot line--.- --• No. of compartments-_---- / Distance from foundation----- - 6e.Width of trench--------- ��- t i Distance from nearest wail-__1'�--- - _ t•�,�y, t��.:� Dis os l Field: Length of each line-_--------- Number oT lines---------------- ':-_�To#al .length-------•-`---��---- =--�-•-. Type of,filter material__-_-- ' :----t----Depth of filter matenaL---- - - nn f Y Seepage Pit: .Distance to nearest well----------------=-----Distance from foundsZienDiamete�__--Disfiance toDneptnst to}.ine_:------------ „ .�. f material.---- --- ---- • -- '� ❑. }umber of pits-_--- -Linting, Liquid Capacity- --------------------------gals. ool: Distance from nearest well----------------„D�stance from foundation----------------.---.Lining ma ------------ - ----------- Cessp ❑ Size: Diameter-- --=-------------- apt ---------------------------------------------------- g------------------------------- Distance from nearest building ------------------- - i -- wra'S _- ------ ---------------------- 1 "- 1 Distance from nearest well----- - .Privy: - �•- --- - �` Distance to nearest lot line--------- ---- -------- --- --------------------- --- ------- --- •--'- ❑i ,_ - Remodeling and/or repairing (describe :-- - ------------------------_ - -•----•------ ------ --•------•------•-----'-'----`-----------------=--`_:-__- --------- - . --•---------- — t _-------------- application and that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared this app „ Mations of the San Joaquin Local Health District.. - ordinances, State laws, and rules and reg f (Owner and/or Contractor) �•�/J f'f1 --------------------------- --;----------------------- > V -- -. - - ._ ---- _-- �- Si nee - - Y!_ e) ( g :�-i ----- --- --- - (plot pian, showing size of system in relation to wails, buildings, etc., can be place an revers of lot, location r FOR DEPARTMENT USE ONLY # r-- <--i/-------- I + DATE--------- 1:> ----- - = ; DATE--------------- ----•------------------------------ ------ APPLICATION ACCEPTED BY------------- ------- !/ DATE------------------------------------------------------------ I REVIEWED BY------ ------ ---. ------- -------- ------ --- . ' _ 1 - B/UILDING PERMIT ISSUED--- ------------,------ _ -- - -- cP;lterattons_and/or,recommendatiorfs:-_ - cam. -- ,,,..;�i � ,' _ , -. sJl19_ �r ---- f- ¢ t ' �4�' 9 ' } 4.-. A- 4 --) : ti ------------- Date _-------- BY.:--=---- ��--S :,;� ----•------ -- FINAL INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C” Street 300 West Oak Street 132 Sycamore Street Bracy, California 130 South American Street Lodi, California Manteca, California Stockton, California • re-4-2M ; IRevised W-2100