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mp� FOR OFFICE USE: Permit No ... ....... ..... APPLICATION FOR SANITATION PERMIT - -- Duplicate) _ Date Issued .-�`-�-�•-'�°-� - --- --------- - - - -- (Complete in Dup ,, _ .... --- --- ------- ---_� ..�.,�� - :This'Permit Expire l�Year From:Date Issued"" - -- ---- -------- _ ereb made to the San Joaquin Local Health District for a permit to construct and install the work herein escrt Application is h y -- t This application is made in compliance with County .Ordinance No: 549. i { 1 �� - (� :. JOB ADDRESS AND LOCATIO g Phone.---_--- ------- ------------------------------------------- .... . ---- }--------- - Owner s _Name- I ----•---•- ------ -------- -------- - •----- ------_----------------- Address -- -----_Address__ --•--- , .�- s o -------; ._._of Motel ❑ ha � Contrac#or's Name ------------- Commercial ❑ Trailer .Court ❑ _ k . A artment House ❑ installation will serve: : Residence ,� p�.� I t Number of livinc} units::_-. Number of t: size bedrooms _- Number ofe } fo WeteoTable(t• ` trivate ❑ Community system Cl❑ r R I�ardpan ❑ j Water Supply: Public ystem r ❑—CI y Loam ❑ Clay ❑ t r of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy -Loam �Vo ❑ f PiA/VA: Yes ❑ Charade , } ,'�� No .[ .New-Construction:^Yes 1 Previous Application Made:. (if Yes, date---- --- : r , i � i TYPE •OF INSTALLATION AND SPECIFICATIONS: i _ _ (No septic. tank or cess ool ermined if public sewer is available within.2on fe ® I Mater +l--.Lr�� / --------- - P- ,-gip-. Distance fromf��atiL uid depth ---- - ----------Capacity___- Septic Tank: Distance fromnearest wall--I`�,Size� �r No. of compartments . ' ~'. i ,+1' %.:_� __Distance to nearest lot�ine._4 ' Distance from foundatioon._._` -_"-- •eng#h of each line_---��- Width of trench--- Disposal Field: Distance from nearest well_--- , , \ - "-��.----- Nu'mber of.lines- a Total len th-�---_-----•-- ®� Dep u datlQ -� To g . --------- -Type of filter material/ Depth of filter ma#ena� YP s� i ----------- 'Of/ to nearest let line-- _.: Distance fro fo ion_. - �i-------- Depth" !. Seepage Pi#:Distance #o nearest, well"__l�I� f�-------- . • ' Size: piameten --- - -- -- - . q Number of,pits"------------Ta:Lining�myaterial__ „,; . . � Distance from nearest well________________distance from foundation____--- _A A' --i fining materia ------- --------------------- 1 _ "----� ( L� d Capaci#y-..---------------- I Cesspool: - ----- ter - - p i' ❑ from nearest well De #h ---- ", '------- - 1 _� Distance r E D from.nearest,b •1 ing" Size: Diameter ��. -. _ ��.�.__._; �....., ------- privy-.t -----•------•---•----- " istance q �T A � ----•----•-' ='a ` o f ❑ '� `�- '"""'Distance to'nearest'lot line._,_,-----------� -'- t -------------•----------- F__ *. _------ -------------- describe): _-_ # . _.._ ______ ______-_____. t Remodeling and/or repairing (ciescnbe�: ' -------=-------=--------: --`--------------- - ---- 7 . s _: _ --- € -- f = -- I -•-•----- ---------- --- - -- --------=---------- --------------- } !__ •... = —------------ - z Ve re ared this ap licatiori and the work will bed one in accordance with San Joaquin County I,hereby certRy-that I ha p p ordinances, State laws, and rules and regulatiions of the San Joaquin Local Heal District. Contractor) = [� 1' k - i��"------------ ----------- 9 ------------ -_-----_ __ __________. _. _____.__ ____..______ - or i Sl ned -- •--- ------------ ------ t� By:------ -- = -- -- ------ ------------------- can Plot plan, showing sizes of lot, location of systems ;-,� tion to wells, buildings, etc., can be placed on reverse sidej.kR � _ 4. -- , r FOR DEPARTMENT USE ONLY 6 `?--------------- DATE---_---------------- - 7 �-�-- ---- APPLICATION ACCEPTED, B - • ------ — _--- --- a _.DATE -- ----------- ---------------------------- ---------------------------------- --------------- ' REVIEWED BY = ---- •----- ----- - DAT BUILDING PERMIT'ISSU1=D__."_ {o, ---.---- - _. 3__ aC_.�.�=_' _ �,� � ------�_, w •------------- Alterations and f or recommends tons.- -_ - - i ______________________________ !�t r- -------------------------------------------•-------• ----------------------------------- ----- ------------= 'r t ------ --- ---------- "_---- --- t _.'_.'-------'- '------------- "---'--i --'-- _ .. _.--_------------------------------------------ -- . ------------ 1 - --- -----. k -- -- - - (.l -- ` ate FINAL- INSPECTION "BY .' --- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 300 West Oak Street 130 South American Stredt �edt, California Manteca, California Stockton, California E6-9 REVIPE9 6-59 P.P.EG. AM 6.6D 205 West 9th Street Tracy, California