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�-- 1761 FOR OFFICE USE: ' Permit No. _ -------------------------- ------------------------------- APPLICATION FOR SANITATION PERMIT ---------------------------------- D (Complete in Duplicate) ----._ ------------- P ) Date Issued ---------------------------------------- This Permit Ex fires 1 Year From'Data Issue 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe d This application is made in compliance wi h_Qounty Ordinance No. 549. ------------------------------, JOB'ADDRESS A LOCATION.... "-- ••-------------- ------ --------- Phone--___-•------------•---••-----•----- + Owner's Name..... ........ p � r --------•----•--------------•--••---" Address. A t!-P�-til ` -- ------- --------••- = _ .--- . ------- I/o;I one---_-------•-•----•------- P Contractor's Name-------- ---------- - ---•---- -F-- •; I " Motel ❑ Other ❑-------------------------------- Number --"--•"�# Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Number baths ----I.- Lot size ____--__.___.- Number of living units: ___--- Number of bedrooms ------ Depth r Water Table _.._____ ft. x Water Supply: Public system ❑ Community system ❑ Private Dep 9 Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam l_J,/Cley Loam❑ Clay ❑ Adobe❑ ❑ I New Construction: Yes ❑ No ElFHA/VA: Yes ❑ No C1' Prenous Application Made: (If'yes,date----------------�-- I No TYPE OF INSTALLATION AND SPECIFICATIONS: ' [No septic tank or cesspool permitted if public sewer is available within 200 feet.) i / Distance from fo+yndation_____1 a--------.Matena•- "" Ca aci �,,rgeptic ank: Distance from nearest well____-.•• ,l Al.- f4Q-fid- No. of compartments------- "'`c'_Siz ........ L'quld depth 'Tp tt line_- Distancetto nearest lot line.___ _..__ —..Dispos Field: Distance from nearest well.. -Distance from foundation _:_l.Width�of trench__-___ r r.. Number of lines-----------.2--------- _-,1_- YLengfh of each line--- _ ., _,, e, _ -- - - •Type of Iter material._' -------depth of filter mafierial__=..""�_�"�"."-.-•--Total length___.--"-�• ?- ------------"- v t • � Seepage Pi}; Distance to Wastes# well______________________Dista Distance from foundation_-----------------Di`stance to nearest lot fine_.._____..._..._ ❑ .Number of pits------- ------Lining material----------________ Size: Diameter --; ------- Depth--------------------------------- Seepage t t ""--Distance from foundation fi_._-_._____---•----Lining material_--------------------------•--- -Cesspool: Distance frm nearest well_____________ -Liquid Capacity------------•---------------ga- {s.`Size: Diameter--------I--------- -------------•---•-Depth--------------------- -------- ❑ m --------------------- \ "� - �.I ❑ neare st well -----------------------------------Distancer Privy Distance from ---------------------- Distance - j _ -- -- Distance to nearestlot line_ .________"----_""-------------------------- ------- + ----- +I - ----------- --•--------- � -_. rRemodeling and/or repairing (describe)----------------------------------------- ------------'- + ----•---•---•-----------------------------• -- --•---------•-----------•---•----•----• --•-------""-----------------"-- i I 1 ------- ------------------•----- - I ty I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, Ste ws, and rules a re latio of the San Joaquin Local Health District. i nd/or Contractor) 5i Wed ` -- -- - -------- i9 )----------- -` r 1- ,'� ' � -----•-------•--- ---"(Tit e)_ 4k (Plot plan, showing size of let, location of system in relati to wells, buildings, etc., can be pieced on reverse side). <' I FOR DEPARTMENT USE ONLY ti - ------ DATE_.c "G`3--------------------------- APPLICATION ACCEPTED BY---- ------------------ --------------- ----- - ----- ------ - - ----- REVIEWED BY. ---------------------------- BUJLDING PERMIT ISSUED---------- -----------------•--------•----------------------------------------•----------------•--- DATE--------------------------------- ------------ --------•-------•-------••-------•--------•-------•--------------------------------- ----•-•-----•--------------------------•---=---- --------•-------•-------- z Alterations and/or recommendations: ------- -------- -----•---------"""- k' t ..___......_.---------------------------------------------------------------- __________________________ .."____-._."_ ________________________________________ _______________ ____________________ _______" _ -------------------- Date :2 7 ' ----------------------------------------------------- FINAL INSPECTION BY:. -.-.- -- -- -- -- '' SAN JOAQUiN LOCAL HEALTH DISTRICT 130 South American Stmt 300 west Oak Street 124 Sycamore 51roe1 205 West 91h Street h Lodl,California Manteca,confornia ?racy,California I Stockton,California ES 9 REVISES 8.54 2M 5-6Z ATLAS M n