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FOR OFFICE USE-. x1 _. Permit No.�-=y....;----�----- APPLICATION FC?R SANITATION PERMIT -------------- , /; Com fete-in.Duplicate] .� -,.. - D`ete Issued--Z.... . Z --------------------- -------- ----------------------- f— s-. ..#:.t`� � P �'"� - - This Permit Expires 1 Year From Date Issued -----------P _. Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No549 I ........................ ----•--------.-----------------.......--- .... JOB ADDRESS AND LOCATION. f ... z-�-�-------��Z-�, �7 --=-------=- -------• Owner's Name---.- ------Q!=OAS_ Ph ----•- Address tx I Phone----------------------------------- r^ -- ----------------'---•_-----_ Installation tors Name__..___.L `�- Motel Other ❑ Contra[ ' tion will serve: Re3idende' ® -Apartment House.❑ Commercial j]' Trailer Court ❑ ff ❑ Number of-living units: _._)_-__ Number of bedrooms -1- Number of baths _ Lot size --------- ----. — --T-- Priva+ e th to Water Table - ft. Water Supply: Public system ❑ Community system ❑ P Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Previous Application Made: (If yes,date__s ............ .1 No ® New Construction: Yes ® No ❑ FHA/VA: Yes No Eli, TYPE OF INSTALLATION`AND SPECIFICATIONS: (No septic tank or cesspool permitted if lit:sewe�is available within 200 feet. i istance from founda}ion____�_L�-___. .Material �5k'-- Q-- Z Septic Tank': Distance from nearest well-- -- ---- , , �� t Size. 4-)`1 --75,,x_Liquid depth---•4---21---------- Capacity.. No. of camp rtments------�--�-�1�--ii--��- ,. Disposal Field: Distance from nearest weH.., Distance from foundation___it.G___...__.Distance-to nearest lot line..--, .......... of lines_.____. ------------------ --Length of each line..------ �--------i�-- Width of trench._..._ _...-------•----------- n IQ: i Type of filter materiial59? - •- Dep}h of filter material_.__1.�------------Total length------(__ '^CQ---................. 7" Seepage Pit: Distance to nearest well----------------------Distance from foundation.._........_..._.._.Distance to nearest lot line................. Number of pits--}------------- ---Lining material-----------------------Size: Diameter-------------'-_' --(Depth---:-•-------------.............. Cesspool: from foundation--------------------Lining material---------.___._____.--------••-;_.._ Distance from nearest well_________________Distance _ ls! — ❑ Size: Diameter--------------------------------------Depth-------------------------------------- Liuid Capacity---------- q -----;---•----------•----•--ga ` Privy: Distance from nearest well-------------------------- -- Distance from nearest building----- -----=-------------••--------------- i ❑ Distance to nearest lot line----- ------------------------------------------------------------ ------- I nnI t 1' Remodeling and/or repairing (describe)------------i_------------------------------- -__-----_--j------------------------------------ - ______.___________------------------------------........I--------- [ ' �- ________________________ ----------------------------------------------------------'------ _____-____. ------------- ----------- -- ----------------------------------S_-._-____--__.._-___.____.--__...------____.__...________.________..____...__-___..__-___..___________.____.._____.__--...._._.___...__._.--__ I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation's of the San Joaquin Local Health District. p f -.------_--________(Owner and/or Contractor Sine ( gd) 1 Title --- ------- -- ------- - --------- (Plot plen, showing size of lot, location of'system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i DATE---- ----------- r „ DATE.._ Z - Z- ------------------ APPLICATION ------- - --- APPLICATION ACCEPTED BY------`�--�---- �S'�- --------------------------------------------------------------- _ REVIEWED BY----------------------------------- -- ----------------------------- --•--------- ------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------------- Alterations and/or recommendations---------------------------------- -- -- ----- _-_--••._____-_----_.. •---.-----•---- ---•-----•---------------------------•------ 4 ---•---- •---•----- ------------------------------------------------------------- - i ... - --'Z'-- ------�.z-.------------ --------------------•------• FINAL INSPECTION BY:..C.._..-.-.. �-�----•---�-------------------------------------- Date----��- SAN JOAQUIN LOCAL HEALTH DISTRICT � 300 West Oak Street 144 Sycamore Street 205 West 91h Street 130 South American Street Tracy,California Stockton,California ` -'Lodi,California � Manteca,California +'o ES 9 REVISED e-59 RM 5-61 ATLAS