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Permit -No. APPLICATION FOR SANITATION PERMIT (complete in Duplicate) Date Issued described. herein clescr Joaquin Local Health District for a permit to construct and install the work Application is hereby made to the San County Ordinance No. 549. 1 rn This application is made in compliance with Co� —---------------------------I------------------------------------- JOB ADDRESS AND .LOCATION----1- -- Phone--------------------------------•--- - 3 ----------- --- -------------------------------------------- Owner's ---I---- Phone-------------------------------- 41�- i----- ------ Owner's Name------ ------- -----------------------------------------------------------I--------- ------------------ Ile--------------- ------- ---Phone_- ----- Address------ ---------- r- ----------- Motel ❑[I Contractor's Name-___--1Commercial C] Trailer Court Other [I Af Installation will serve: Residence X Apa;rfm��nf House CO Lot size ---- ------------------- - 13 Number of living units: I--- Number of bedrooms --.% Number of baths --./-th to Water Table -.5jft. stem 0 Private x Dep Water Supply: Public system F1 Community SY Gravel n I Sandy Loam 0 Clay Loam [I Clay 0 Adobe K Hardpan 0 depth of 3 feet: Sand E] Character of soil to a Na [] New Construction: Yes 0 No ❑[I Previous Application Made: Yes 0 TYPE OF INSTALLATION AND SPECIFICATIONS: sewer is available within 200 feet.) (No septic tank or cesspool permitted if public sew ounclation---------------------Material---- -------------------------------- Septic Tank: Distance from nearest well-----------------Distance from f Liquid depth--------------------------Capacity----------------------` No. -------Capacity----------------------- No. of compartments---_--------------- Size-------------------------------- --------------------Distance to nearest lot line--------------—, 11 t --- ------- -- Distance from nearest well-----------------Distance from foundation Width of trench----------------------- Disposal Field: umber of lines----------------- Length of each line----------------------------------Total length------------------------------------------ 4Z,pr.v�� N ...........Depth of filter material-__--__--_------------ Type of fill-es material-------------- 4* — Distance to nearest lot line----- ---------- .1 7 rom foundation -- -- --------- Depth------"w = ------ ------ nrest well----4 ---9---------Distan i ete ------ Distance to nearest r----*3 Seepage Pit: ,, j------------Lining mate . ..... If pits------- al I�Z Number 4 e from foundation- -----------------Lining material--------------------------------- Distance from nearest well_--__.___-- D�s nc --- ----------------Liquid Capacity----------------------------ga S. Cesspool:. h------------------------ ---------- tan mater -------------- h-- ---- ----- -------- Size: Diameter_ -------------------------------De r�,,4-- f rlr F1 Distance from nearest building------------------------------------------ earest well------------------------------------------------- -------------------- Distance from n --------------------------------------- Privy: I Distance to nearest lot line------------------------------------------------------------------------------- ❑ --------------------- ---------------- ------------ --- ---- - ---- ---------------------------- -------- ------------------------------ Remodeling and/or repairing (describe ------------ ----------- ---------------------------------------- ------- - - --- ----- --------/------------------------------------------------------------ ------------ ------------------------------------------------------------------- I. -- --------------------------------------------------------------- - --------------------------------------------------- -----------------------------—1------------------------------------------ --i.pplication and that the work will be done in accordance with San Joaquin County I hereby certify that I have prepared this a Joaquin Local,Health District. I laws, and rules and regulations of the San ordinances State I e Owner, and/or Contractor) ------------ —— ----- ----- ----------------- 7 ----------------- can (Signed)----- ---------- ---------- ----------------- ------------------------------- ------------------- reverse side). By:------ - - — --.- - - . , — �i;, buildings, etc be placed on �17e of lot, location of system in relation to wells, (Plot plan. showing FOR DEPARTMENT USE ONLY • DATE--- ---------------------------------------------------- -------- ----------------------------------------------- -------- - 0 ACCEPTED BY-------------- --------- ------ --------------------------------- DATE--- APPLICATION A DATE----- ----------------------------------------- ---------- REVIEWED BY-------------------------------------- --5 -------------------------------------------- ----------------------------------------- BUILDING PERMIT ISSUED--------'-- 4---- __;------------------- -------------------------------------------------------------------------- ------ Alterations and/or recommendations:---------------------------------------- -------------------------------------------------------------- --------- ------------I ---------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------------------I--------------------- --------------------------------------------------I-------—---------------------------- -------------------------------------------------------------------------------------------------------------------- --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------- -- ---------------------------I------------------------------------------I -------------------- --- Date---------�XA •A ----- ------ ------ ------------------ ------------------------- FINAL INSPECTION BY SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North .'C" 'C" street300 West Oak Street 132 sycamore Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California ES—i?-2M 8-51 .Revised W-2100