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FOR OFFICE USE: ----------------------------------------- --------- --- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ ------------- -.1------------- --------- --- ------------------------------- ---------- (Complete in Duplicate) Aa� Date issued --------------------- This Permit Expires I Year From Date Issued ... ....... ------ Application is hereby 6de to the San,Joaquin Local Health District for a permit-`o construct and install the work herein described, This application is made-in c mplianlip e'with County Ordinance No. 549. JOBADDRESS ARD L ATI -------- Phone------------------------------------ Owner's -------------------------------------------------- ----------------------------------------- J�j F- --------------------------------- _-_i I --------------------- Address_ V Phone__'!';� U��m---------- -- ------------------------------ Contractor's Name-______ - Motel 0 Other Installation will serve: 'Residence [9/Apartment House El CommercialE] Trailer Court 0 Number of living units: __/--- Number..of_bedrooms _-2 ----------------- oms —Number of baths -- Lot size --------- ------------------------------- Private Ul" Depth to Water Table -------- ft. Wate'r Supply: Public system El. Cor I nmunity system El Clay L08ME] Clay C] Adobe 0 Hardpan Ell,, Character of soil to a depth of 3 feet:I Sand E] Gravel E] Sandy Loam 0 ion Yes E] No E] FHA/VA: Yes ❑ No El Previous Application Made: (if yes,date------ -------------) No F-l New Construct __'TYPE OF INSTALLATION AND. SPECIFICATIONS: (No septic tank or cesspool Pern�iitted-if public)ewer is available within 200 feet.) nearest well ------Distan.ce from fou -----Material ---------------- of CoMpr 9datip -----Capacity,- ------a Septic;ank: D;Sfance from,ne ----- 'Size-- e flX -a' i 'Liquid dep.th---------- - ----- Eirtme ------- ------- - -f -4--- . X N 6.. . nfs-------- . - i_ nearest Iodine_--__".________' 'DjsposalField: Distance from nearest well____ ---.,-Distance from foundation_-_-_ O-__---Distance to nr 4 french------ --------------------- _.0 �. .........Width of f each line----- ' le Nu'rnber of lines-----------;k---------- ---------Length -------------- ---------- jype of filter_material__"___ +----------Depth-of filter ------------Total length---- ---- material- )rest lot line .___----- Linin foundation----/f Distance to nee Distance to nearest well- __--__----Distance -------- Seepa� Number of pifs'--_'.Q-----------Lining material--- '------Size: Diameter-----33----------- -Depfh__P�-- --------:--------- Number -------:--------- 'earesf well from foundation-------------:"____Liquid -------- Lining material---------------------------------- -- Cesspool- Distance' from.n --------------- -Distance -- -- ---Liquid Capacity____. gals- 11 Size: Diameter------- ------------------- -----------Depth------------------------------------ --- ------------------- ------- Privy- Disfance-frorn nearest well------------------------------------------------Distance- from nearest building- ------- Di lest lot line---------------------------- ----- --------------------------------------------------------------------------------------------------------- ❑ sfan.ce to near - -------------------------------------------------------------------------------------- Remodeling and/or repairing '(clesc'!ibe):------------------------------------------------------------------ ------------------------------------------------ -- ----------------------------------- --------- ---1--- 4 - --------------------------------------------------------------- 7 .1. ; ; -4 --------------------------------------------------------------- A Z�----------- ---------- ------------ ------ ------------------I------------------- - --------- ----------------------------------------------1__. --------------------------------------------------------------------------------------- ------------------ , ? i�ll--------------------------------------------------- - -------------------------- --------------------------- I hereby certify-,that I have pr;pared this 'application ancl'that the work will be done in accordance with San Joaquin County of the San Joaquin Local Health District. ordinances, State/_Ia�s,,and rules ad re tions and/or Contractorl i--- --- ---- -------�eA--------------------------------------------- - ----------------------- (Signed)---------- ----------- ---------------------(Title)-------------------------------- ------------- -- ------------ ------------------------- -------------By:----- -- se side). ion 'i sys in r can be placed on reverse(plot plan. showing size of.lot, loc6f of syst in rely to r wells,.buildings, etc A FOR DEPARTMENT USE ONLY DATE--- ---------------------------- APPLICATION ACCEPTED --------------- ---------------------------- DATE---/Z ----------------------------------- ------------------------ REVIEWED BY------------------- -- -- - ------------------------------------ --------- -------------- --------------- _ DATE"- :---------------------- BUILDING PERMIT ISSUED------------------ ------------------ -----------------------—--------------------- ---------------------------------- --------------------------- Alterations.and/or recommendafions:------ ------- --------------------- ------- ---------------------------------------------- ---------------- ------------------------------ ------ ---------------------- ------------------I---------I------------------------------------------------------------------------ ------------------------------- ----------------------------------------------------------- - --------------------------------------- JE-------------::------------------------------------------------ r - ----------- -------------------------------------- ----------------------- ------------------ ------- --------- - ------------------------ ---------------------------- ---------- ------------------------------ -------------------------------------�--------------------------------------- --------------I-------------------- --------------------------------------------------- ----------- FINAL [NSPECTIONBY_A_ ..........I-------- bate-- --------- ------------------------------------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 911h Street 1601 E.Hoselton Ave. Tracy,California Stockton,California Lodi,California Manteca,California ES 9 REVISED 8-59 3M 3-'63 F.PZD.