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Permit No. APPLICATION FOR -SANITATION PERMIT- r(J( ADPL , (Complete in Duplicate) Date Issued 'c+r tall the work herein described. Applica-6ion is hereby made to the_San Joaquin-Local-Health District for a permit to const#ct and ins This application is made in complia'fnce with County Ordinance No. S 49. I xc� JOB ADDRESS AND LOCATION!______V�1/ - - Phone__/ -------- .--9:7 " ` t ------------ - -------------------------- /V _ Owner's Name________� - ' - ."---."'.. ------- ----- l . -.-, ------•--------•- o------------ Address a ------------• Phone r � � { Other Contractor's Name------------- .- } Motel ❑ .4 ❑ ? art:ment House ❑ Comme.rcial*Q+�;Trailer Court ❑ Installation will serve: Residence p ,3--------------------------- f Lot Number of living units: J-1 Number of bedrooms'____. Number of baths Private Depth to Water Table Pp y. Publics stem'❑ Community system ❑ — .-�--w Adobe�ardpan ❑ ' Water Su I ' Y -�" Sand Loam❑ Clay Loam ❑ Clay ❑ --� "'-Graveh❑ Y Character of sail to a depth of 3 fleet: Sand ❑ �.,�1 o El No New Construction: Yes LTJ" N Previous Application Made: Yes ❑ k - , IONS- TYPE OiFVoNeP cLta kO ce NDOoSP�rCm �d ff u lic e er is available within 200 feeFIC t.] i ' p rP p �"'.' : ( ..,�,.._,> a Jr0 ateriai-� -------------- ----------------- 4Tank: k Distance from neares we! _____-___._ Distance from founda�son____�-- e Septic Size__•✓r6__�'S� X� Liquid depth �' Cap acity. �f Y Y' ,No. of compartments_ ._.___--_ i t„,, 1 __Len th�of each ine______7S'---------•-----Widthlof trench-._.jy---.------ Disposal Field: Distance from nearest 'well--- from"fo�"�d on-•--��-,-------Disfiance to near�t lot ine_________________ � •� Number of lines----:--- �- 9 �a Total length----- Ty%pe or filter material _.-___lT_ ____-Depth of f�l r'materialt-__ i Distance to nearest lot line________________ # . t �� + ' ..°� •' _ �Size: Diameter-- 3-�------ ----.Deptn---- ----°�------------�--•--- Seepage Pit: Dis}ante to nearest weNL1l17S____�___--Distance from fou.n a :ion_._ __.- Number of.pits._:�C'___ --- --Lining material. - r F .. ' Cesspool: Distance'from;:-Weare �ell______.- __Distance from foundat:ion------------_______Lining material__.----•_---- i I ---.Depth--------------- .Liquid Capacity------------- i gals. ❑ Size: Dia r_-. � .�.�,,. ..Distance from nearest bIding- h - Distance fromnearest `dell - 1------•------- 1 Privy'. -- --- ---------•---•----------- - ❑ - Distance to nearest to#, 9ie.------- --------=- - j 'A , r ------------------------------ gS , - -- - ------ �... remodeling and/or repairin (describe !---- 1 -----•------ `' ------------------ y - _______________ ------------- -------------------------------------------------- _____________________ _ 1 _--------__----------------------------------- - ___ j ' `.y this application and that the work will be done in accordance with San JoaquinCounty } I hereby certify-tlhat I have Prepared 1 ordinances, State laws,and rules and regulations of the San Joaquin Local Health District. s } { (Q ner and/or Contract arj ----- ----- Si Wed �--T-�+- t-t�--- --- - �- -- ( � � --- --------------- _ T tl i e By:------ ------ ells, buildings, etc., can be placed an reverse sr e. (Plot plan, showing size of lot, location of sy m in relation to w FOR DEPARTMENT USE ONLY , _ F DATE---- APPLICATIONACCEPTED BY---- -------------- -- - - - - ------------- DATE--------------------I-------------------------------------- REVIEWED ------------------=------------------------------------- REVIEWED BY---------------- ------------------------------------------- - -----•------- ---------------•--=------- -----�----------- DATE---- ------•---------------- --- - --•------ SUILDING PERMIT 15SUED.__. =`- -------------- ----------------------------- --•=----------'----------------------- Alterations and/or recommendations:____-_._-- --- •-----••==--- ---- ations: •f -•------------- -- ------•------ ------------- -- ----• ------ ----- =------------ . . .----- ---------•---------------- 1 Date-- ------ _ FINAL INSPECTION BY.___:__---------------• SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street �. 132 sycamore Street 300 west Oak Street Tracy, California t30 South American Street Men+ece, California Stockton, California Lodi, California __ _ 0e.4-4 W-2100 —