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FOR OFFICE USE: permit No. '114, -----------------"------------ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) -------------------------------------------------------- -------------- -- -- ----- ---- Date" _1�--=-�-- . - This Permit Ex ices 1 Year From Date Issued - Applicationstall the is hereby made to the San Joaquin Local Health District for a permit to construct andinwork herein described. This application is made-in compliance with County Ordinance No. 549. k ?555 S,_ F�4 c a --- - -- -------------- ------ JOB ADDRESS AND OCATION------------- ---- - -------------------- -- -------- -------- Owner's Name ---- - --•- ----_ _.. y -------- Address Pone - ------ -----------•----------------------------------------- --•-- ----.- Motel ❑ Other El Contractor's Name____________________ Trailer Court ❑ Installation will serve; .Residen e �' Apartment House ❑ Commercial ❑ 3 - Number of baths ______2ESt size ._.______- Number of living units: _ ------ Number of bedrooms _ }h to Water Tabled-�- ft, Communitysystem ❑. Private DeP Water Supply: Public'system ❑ Y y P ` Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam Y No ❑ FNA/VA: Yes ❑ NoI } No New Construction. Yes Previous Application Made: (If yes,date---------------- I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti Tank: Distance from nearest wail___- --�----Distance f f�X#� atiL q �-d t a�rial-- - Capacity--f es Q Size__.___ ----- �/S Dis#ante to nearest lot li e_._. No. of compartments----��------- -- -- _ �--•- I mm Distance from foundation______________.__ _ \. ` Disposal Field: Distance from nearest weil..Q"D --.-Length of each line--5_J( ------- Width of trench___ -- ---- ------ �in4 Number of lines'____ =----- ' 4 --- i �~�,�, �1 Total length____"- -----------" � Type of filter materia-- of filter material___"�-�Q Distance o nearest lot linet k Distance to nearest`weil.,._ __2�0_ ---.Distance ro fo ati /)Seeps a Pit$ [33 mamet ��A�_4 �,}�Number of pits_ Lining m e !i 2 �L�`-e J --------------------Distance from nearest wail_________________Distance rom foundation3.-.__.________--Lining mater+ gals. Cesspool: ------------------------Liquid Capacity------------------- ------- ----,:--- -- T Y t -Depth---------------------------- Size: - ❑ Diameter. - --------- - Distance from neo e t weli_��__"'°"' w - ^ Distance rom nearest building - Privy:'_ . --- ❑ Distance to nearest lot-line----- ----------—-------------- I ------- --- /fir-�--�!`________ ___ ___• __________-_ _•_-•____ � i _.._ Remodeling and/of repairing describe):___ -- __ -------- ----------------- ------ I' _ _ -------------" - { � -- -- ------ - - --------------- ---- - - :: ------------------ tion and ----------------------- ------------------------------ I hereby certify that I have prepared this olf the San JoLocalL cal Health Districtbe done . accordance with San Joaquin County ordinances, State laws, and rules.and regulations � - [Owner and/or Contractor) --------- ---=----= -----------"---- -------------- (Signeg ----- •-- -- _(Title)._ of lot, location of system to relation.to wails, buildings, etc., can be placed on rev (Piot plan, showing sizeerse.si e. FOR DEPARTMENT USE ONLY AT E- APPLICATION ACCEPTED BY = - ATE------- ------------------- ----------- -777 _a -- REVIEWED BY---------------------------------------------- - QATE--------- CID = -----------------. BUILDING PERMIT ISSUED----------- --- _.; -------- -----°----- - ---•-- ---- Alterations and/or recommen a tons:_____---------------- ___.__-____------------ ----- •------------- ---- ----- ---------•---- .----- -- --- .. ....� ------ RNAL INSPECTION BY---------- ---- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 300 West Oak Street Tracy,California Lodi,California 1601 E.HaTalton Ave. �_=;�,anteca,California Stockton,California E5 % REVISED 9-59 3M 3•'63 F.R.0 D.