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FOR OFFICE USE: ="-"--- --------- -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .__ ..�7--- --•- -• ` - - ------- ------- ------ "-- (Complete in Duplicate) _ _. ' Date issued __.'�Z� (a - This Permit Expires 1 Year From Date Issued 4.t ------------------------------------ -------------Application is hereb made to the Safi'Joaquin Local Health District for a permit to construct and install the work herein de Application This application is made in compliance'with County Ordinance No. S49. ( .� C_I iQ Q.J • ___.-_ __� -` ------ JOB ADDRESS AND+ qATION___4._ Phone.... ----•------- Owner's � Address----. r U � one • -••--•-•- . . • • ------ Ph ' _. -•- --- ••--rte - ---•�-------•-----------•--•- Contractor's Name________________ 4 • - Motel Other ❑ I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: ._I___ Number of bedrooms __Number of baths __ Lot size ....,lf_-6?—�---------------------------------- ' Private 16' Depth To Water Table -------- ft- ! Water Supply: Public system ❑ Community system ❑ Cla Loam Cla Adobe I(Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ y ❑ No ❑FHA/VA: Yes ❑ No ❑ Previous Application Made: (If yes,date___________________) No ❑ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4 'No'septic tank or_cesspool permitted'if public sewer is available within 200 feet.) :. _ __ Septic Tank: Distance from nearest well__-_________-_._Distance from foundation uid de th_"Material.----"-'_Capacity ❑ No. of compartments___________________ Size_.. q p. -•----------------••--- s Dispos Field: Distance from nearest well..-J&---__Distance from foundation.___E----------------------------- -----Distance to nearest lot Iine....S..___..._.. Number of lines---•-------- ---------- ---------Length of each line--- -a------is-----Width of trench-----�ciF----------------------- - .. Type of filter material. -A-�--Depth of filter material------- ----"------Total length__...__ - 7__.""•---.._---•• •- 1I 01 ........�Se � Distance to nearest well �P.- Distance from foundation----/-Q-- Distance too nearest lot line..._. � l ❑ Number of pits__-.-----I-----------Lining materia l.__--•---Size: r ____: _-6--"--Depth------- -----•- Cesspool: Distance from nearest well-----.______-.."Distance from foundation_-_.____--____.__-.Lining material_________________________________a-s i C7 I De th Liquid Capacity----------------------------g ❑ Size: Diameter—---------•--------------- p (>, ' Privy: Distance from nearest well---------------- -------------------------Distance from nearest buildin""------------------------------" """ ❑ Distance to nearest lot line------------------------ ------ --- --- ----•---------------••------------------••----•---•------ R�+ r repairing describe� ------------------------ -------•---------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun tY •---- ---- ---------- --- • " q I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. iJ --------•--------•----- .. ------- �------------------- ,------- - ----••-•-----------.r..(i�MrwiiFrwnd/or Contractor (Signed) (rtl --------------------------------------------- �.:: 4:"- B � _ ----------- = _ - e1 Y ev of system in re ion to wells, buildings, etc., can be placed on r (Plat plan, showing size of lot, locetionerse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--Z?!! ------------------- Y-- - - - --- DATE_. d=�'3 • .. --------- REVIEWED BY--------------------------------------------------- -------------------------------------------------------------- DATE...•--------------- - DATE..--•--------••---------•------------------------------------ BUILDING ------------------------- --3UILDING PERMIT ISSUED-------------------------------------------------------•------------------------- - - ----•--------•--------...---------•- Alterations and/or recommen a ions--------------------------- - - -------- --------------- FINAL INSPECTION BY:._ _- -f ---- Date---- �- --- -•-----------•----------------------------------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT `' 124 Sycamore Street 205 West 9th Street 130 South American Street 300 West Oak Srreet Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISER 9-59 2M 5-62 ATLAS