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- — , FO OFFICE USE: ! - Permit No. �� I - ------------ U APPLICATION FOR SANITATION PERMIT ------ - S' -.yam- r _..__. (Complete in Duplicate) Date Issued -----_----� --- - -------------------- This Permit Ex fres 1 Year Fjom Date Issued . ---------- Application is hereby made to.the San Joaquin Local O Health for a permit to construct and install the work herein described. This application is made in compliance with County ------------•-------- JOB ADDRESS AN LOCATION S/I _ - Phone ----------------------------•---- Owner s Name___________________•--- , V e3 €�' Address S �, Phone -----••-• ---------- Other Contractor's Name___________________UMotel ❑ � ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ l I _...Number of baths -1 ---Lot size ____ _________ __ Number of living. units: _�_____ Nub ber of bedrooms .- - Depth to Water Table -.3-tit, - t• ' Water Su Public system R Community system ❑ Private ❑ p Supply-. Cla Loam ❑ Clay ❑ Adobe Hardpan ❑ Charac+er of soil to a depth of 3 fest: Sand ❑ Gravel ❑ S dy Loam ❑ y If es data--------------- ----) No New Construction: Yes WNo ❑ FHA/VA: Yes ❑ No Previous Application Made: ( Y Q TYPE OF INSTALLATION AND SPECIFICATIONS: ^+' -(No septic tank or cesspool permitted if public sewer is available within 2d0 fee`.) G� �CtrX_.! Liquid depth ---------------------------- Capacity_Matena___.__.- Septic ani: Distance from nearest well_ "_.----Distance from foundation_______________ r No. of compartments_..2--------- --------Size__-•_- -- i Dispos l Field; Distance from nearest well....'-:-:-----__.Distance from foundation_IQ_r_._`-----.Distance #o nearest lot I41 ine�._-------- !Len th of each line----'¢-0-------------------Width of trench-.�--,------------ Number of lines.._:_° - ----- g _�Ck Depth of filter matenal_�_rlr_------�`------Total _length-----kp--••-=---• ----------- Type of filter material_-------- ------`_.. 1 I See pa a Pit: Distance to nearest well----- -_---- Distance from foundation__f0__._--.--___.Distance fio nearest lot line_--_.________.__ / 33�---------.Depth----- Number of p+ts4-.__ -- ----- -Lining materlaL__ �-C--�-----Size: Diameter._. • d ng Cesspool: Distance from nearest well---------------:-Distance from foundation-------------- Ltinuid aerial gals. i ❑ Size: Diameter---------------------------- -------Depth--- --------------------------- t --------- ------- = q. Capacity - ,----Distance from nearest building-----------------------------=-------- Privy: Distance from nearest well-------------------- ---------------------- --------- Distance to nearest of line_---- ------------------- , El I Remodeling and/or repairing (describe)---- ------------- -- ----------------------•--•--------;-----•---------------------- ---------------------•---•-------- ----------------- ---------------- i ------------------•------- -----------------•-------- --------------------------------------------------------------------------------- ------------------------------------ -------------------------------- I hereby certify that I have prIklication and that the work will 'be done.in accordance with San Joaquin oun y } ordinances, State laws, and rules af +he San Joaquin Local Health District.r --------------------(Owner and/or Contractor) --•--- ----------------------------------------%------- (Signed)--- ----------------------------- ------ ---- (Title)--------- -------------------------------- ------ - --- - By:--••-------•--•---------------- -- -- - ------------------------------------------------------------ (Plot plan, showing size of lot, 1oca+ion of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY ----------------- ; - ----- DATE---•---------- .-� --- ---- ---- APPLICATION ACCEPTED BY -�':F ------ DATE--------------- --------- ---- --- ------------------------- iREVIEWED BY--------------------------------------------- ----- -------------- ------------ ------------------------ DATE--------------------------------------------- ----------•----- BUILDING PERMIT ISSUED--------------------------------------------------------•---------- •:---=-- I - Ai+ere+' ns and/ recommendati �`-- ---�,1�� .� ------------ -- r ---.-------_--.__-__ -_ __ _______________________________________ _--.-._--. --------------- ---- - kDate ---------�.._�.,Y_... _.. --------- -------- FINAL INSPECTION BY:-------- - '7---------- - I ' SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1601 E.Harelton Ave. 300 West Oak Street Lodi,California Manteca,California Tracy,California Stockton,California r ES 9 REVISED 8-59 3M 3-'63 "-CQ.