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FOR OFFICE USE: <br /> APPLICATION. k1111 SANITATION PERMIT <br /> Permit No. J--• -- . <br /> - ---------------------- <br />--------------------------------- - <br /> (Corrlpliete in Duplicate) Date Issued .`�--y*-�--�---�/ <br /> This Permit Ex ire 1 Year From Date Issued <br /> ------ y <br /> Application is hereby made to the San Joaquin Local Heal. <br /> District for a permit to construct and install the work herein describe . <br /> This application is made in compliance with County Ordinar ;e No. 549. <br /> - 14-eL <br /> ------------------------- <br /> CATION-_•�� A/ -JOB ADDRESS AND <br /> Phone------------------------------•---- <br /> Owner's Name-- ...... -----='-------•- <br /> -----•-------•------- <br /> -----•--------------------• -----••----•--------•-------••---------•---•- <br /> - <br /> Address--------------- <br /> - ----- Phone----------------------------------- <br /> ------------------------•------- -- <br /> Contractor's Name...... - <br /> � j Motel El Other 11Installation will serve: Residence f& Apartment House Commercial E] Trailer �t .© <br /> x '�,°----------------------------- <br /> Number of living units: -:1-- Number of bedrooms ------- Number of baths Lot size ------ <br /> Community system E] Private ® Depth to Water Table �o-- ft. <br /> Water Supply: Public system C1Y y Clay Loam Clay ❑ Adobe❑ Hardpan 1@ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [4} Sandy Loam ❑ Y ® No FHA/VA: Yes ❑ No ❑ <br /> Previous Application Made: [If yes date--------------------) Nv❑ New Construction: Yes ❑ ❑ t1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: l� <br /> 4 [No septic tank or cesspool permitted if public sew is available within 200 feet` <br /> _x � <br /> Septic Tank: Distance from nearest well____$"�+_____-Dh fan',ce� from foundation ___ ___-.Materia_____________ o <br /> S�e -- •- -�X--- ---------Liquid depth--------- ---------------Capacity- <br /> No. of compartments_._--�-_ -- � <br /> Disposal Field: Distance from nearest wail._-ted_____--_D{stance from -- ------------D�sthcofttrench�5t lot l= •line------=---------• <br /> ® Number of lines-_-.--- "---------- Lrmgth of each line--_--j -4a------------ <br /> ° -------------------------- <br /> i <br /> Type of filter material_-�T* ---Di[pth of filter materia l___-------___!___----Total length________.-___ e <br /> Seepage Pit: Distance to nearest well_____-15�!---'-----Drstance from foundation----�_�___.._____.Distance tonast�loY lfne_�-_-------- � <br /> _ T ------- Size: Diameter----�)J------------ Depth- <br /> Number \l <br /> of pits 'LEQ --Lini*g m ria- <br /> Distance from nearest well_________ _______Distance from foundation--------------------Lining material___.____.--_________.__.__---------- <br /> Cesspool: Liquid Capacity_ __-______gals. <br /> -Dath------------------------------------------------- q P Y <br /> ❑ Size: Diameter------------------------------------ � <br /> ` Distance from nearest well_-______----------,----------------------------- <br /> Distance from nearest building---__________________________<----------. <br /> Privy: --- <br /> Distance to nearest lot line__. _-`____ -- "---- <br /> -------------------------------------------------------- <br /> �, <br /> Remodeling and/or repairing (descrsbe):------__. . ___ _ --_.._ ` <br /> ! ---------------------------[------------------------------------- - - ------------- ------------------------------------------------------------ <br /> 14 <br /> ------------------- <br /> --------------------------------------------•------•-------------------- - - - <br /> I hereby certify that I have prepared this applicatic;:i and that the work will be done in accordance with San oaquin oun y <br /> ordinances,�V.,x, <br /> s, and les and re ions o e fan Joaquin Local Health District. <br /> i _ _ --- <br /> ----- --------------------------------[Owner and/or Contractor) <br /> [Signed}___ <br /> _ s V .. [Title)----------------------------------------- <br /> - - ------- <br /> S stem in rela _ = - ' - ._'id <br /> 'i - - •� <br /> _ _ <br /> B ' __:_ <br /> I • y' -- n to wells, buildings, etc., can be placed on reverses <br /> (plot plan, showing size of tat, notation of ,y <br /> FOR DEPARTMENT.USE ONLY <br /> APPLICATION ACCEPTED BY - .__._ 7- ------------ <br /> DATE__ ' - _ --------------------------------- <br /> DATE-------------------------------------------------------- -- <br /> REVIEWEDBY-------------------------------- -------- ----------- ------ --- <br /> -------- <br /> BUILDING PERMIT ISSUED--------------------------------------- ------- --------- DATE-- ----------------------------------- ---------------• <br /> --------- ----------------------------------------------- ------------ <br /> Alterations and/or recommendations:._________..................... <br /> -------------------------------------------- - ---------- <br /> --•-------------- -- --- -------------------- ---------------------- ---- ------- <br /> Date----- - �3-- ---- -- <br /> FINAL INSPECTION BY: ? � --------- <br /> SAN JOAQhIIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Sire, <br /> 124 sycamore Street 205 West 9th Street <br /> 1601 E.Haselion Ave. <br /> Manteca,California Tracy,California <br /> Stockton,California Lodi,California <br /> K5 9 REVI6EP 8-59 3M 3-'63 F.P.0 P- <br /> "_ .. _2 <br />