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• � No. ___..:-v-.••---- APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicatel Date Issued This Permit Expires 1 Year from Date Issued A lication is hereby made to the San Joaquin Local Health D'No �pCtfor 549 .6 a permit to construct and install the work herein describ 'd. in.compliance with County Ordinance This application .�s made, JOB ADDRESS AND LOCATION9Ip " Phone - ..................... Owner's Name_ ------------------ G - �----�•---•--•------------------------------•----------------•----'-------------•-- ---• -------- Address-----•------ ---------------•---------------•------------------------------- - !3 Phone --- - --- - ,r ---- - - Contractor's Name___ Motel E] Other [IInstallation will serve: Residence [a Apartment House 171Commercial ❑ Trailer Court (3 Number of living units: I------ Number of bedrooms to--- Number of baths J____ Lot size --_- ---------- Community system ❑ Private ® Depth to Water Table4';--- ft. Water Supply: Public system ❑ Y Y Clay Adobe❑ ' Hardpan'I] Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Y ❑ Previous Application Made: Yes [-INo5] New Construction: Yes Qr No ❑ FHA/VA: Yes ❑ No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] �x� �� Liquid depth__. -----------------Capacityj;2�06 Tank: Distance from nearest well__--------pis#ante fr m foundation -------------.Materia ____- No. of compartments------------------ ---size.__.---- Disposal Field: Distance from nearest well___4- ____--_Distance from foundation_._a_o-------------Distance to nearest lot line_s,_-______.__ Length of each line----_l—-------------------Width of french-._, f644-------------- ------- �, Number of lines_ -----I----------- --------------- g Type of filter material \ Depth of filter material--Ai T'�------------Total length-- I.�---------------------------' Seepage Pit: Distance to nearest well---_---Linin material from foundation--iameter-_ Distance tonearestlot line----------------- Seepage -__=--.-'_ � ❑ Number of pits--------------- g Distance from nearest well-----------------Distance from foundation.--------------"- Linuid Caing fieacit rial------------------------------------- Cesspool: gals. Deth--------- ------------------------ ---------------- q Capacity Size: Diamefier-------------------------------------- p ___Distance from nearest building ------ .............................................. ----- Privy: Distance from nearest well------------------------- - ❑ Distance to nearest lot line-------------------------------------- --- C Remodeling and/or repairing (describe)----------- -------------- --------------------------------------------- ------------------- --------------------------------------- ------ I hereby certify that I have preparedthis ons olf the San Joaquin hLocal kHeall Health {rIc . }n accordance with San Joaquin County ordinances, State laws, and rules and reg _----------------------(Owner and/or Contractor] Ae-J, " (Signed) (Title) SY . .-... �.- ---- ---------------------------------------- etc., [Plot plan, showing size of lot, locati system in relation to wells, buildings, can be placed on reverse side). FOR DEPARTMENT USE ONLY - - --------------------------------------- APPLICATION ACCEPTED 13Y_-- --- - - -- - --- - - REVIEWED BY----------------------------------- -------------- ----•--- - -- --- ------------------------ DATE--- ----------------------------------------------- ------ ----------- --------------------- BUILDING PERMIT ISSUED-__--------------------------------------------------------- ---------------------------------- ------------• ---------------------------- ------------------------------ Alterations and/or recommen ations:._.__--------------- ---__---_-------_----_________- ------------ --- --------------------- - - --- `/�J / Y - -- -- _______________________________________ ' -------------- r---- "- FINAL INSPECTION BY:.... - - - -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Strout Tracy. California Stockton, California .Lodi, California Manteca, California ES-9-2M Revised 6-'59 FYCO- –