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i r'O'AION FOR SANITATION PERMIT Permit No.PPLi AT / r (Complete in Duplicate) / P } ba#e Issued -�-�'-�3`---�-� -� App ication is hereby made to the San Joaquin Local HealthdDistrict o a permit to const Iuct and install the work herein described. This application is made in compliance with y _ JOB ADDRESS AND LOCATION_-;-- f = Phone-------_---- I ' � _ ------------.-------------- Owners Name__-__--- / -- - Address ' ------------ ----------------- t-_--------------------- one ! --- ---------------- - ph _._.C� - -- ----` Contractor's Name_________ Motel Other ❑ , i Commercial Trailer Court ❑ ❑. Installation will serve: Residence . Apartment House ❑ ❑ � � ----- ----------- Number of living uitsn : =_ _._ Number of bedrooms _ Number of baths __j---- Lot size ______ ________ ' Private De th"to 'Water Table _ ft= I Water Supply: Public'system ❑ Community system ❑ p' Cla Loam Cla Adobe®. Hardpan ❑ r Character of soil to a dap#h of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ y FHA ❑ Yes No EDI Previous Application Made: Yes El No � New Construction: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: {(No septic tanke or'cesspool permitted if public sewer is available within 200 feet.) i _ a ", S c ank: Distance from nearest well_____--_____.--Distance from foundation_ __�e_;�h-Material__--------Capacity----------------------- C _____________ _______ ; No.'of compartments---- --------------- ---Sizer-------------- Liquidp'P �--! k r t I 0?.-.__Dis#ante to nearest lot line.-iS------ ' osal Field: Qistance from nearest welL__�-1�- -.--Distance from foundation____ � Width of trench____- -- ------ jy+ Number of lines----------- ---------------Length of each line__________ Q--r F "" e . th of filter material---.--��_--=Total length-------��-------------------------- Type =-_- ----- --------- ---Type of filter material_____ 4't-� C-Dep r + +" Distance to nearest lot line__ s ---- X16 � ; page Pit: Distance to nearest well____�______________Distance from foundation-__ 31� !� Depth_.�CS~f-------- -' Number of as----- _--------------- _ _ __Lining material___ ---Size: Diameter__ -_r 1. p Cesspool: Distance from nearest well-_____,__-------DeDistance tante from foundation---------------------Cr Lini Capacity_ ________________.-- gals. ❑ Size: Diameter p Distance from nearest well_-__.____: Distance from nearest building__________________________.-------- --- Privy: r -------------- > ------- -��-------------------- ❑ Distance to nearest lot line__-__________________ --; -- ---------------------- ----- --------- ---t Remodeling /or repairing (describe --------------•------------- ---------------- 40- - -------- ---------------- } �* t y p P .. I hereby certify'that I have .re orad this�a'pplication and that the work wiil 'be done in accordance with San Joaquin County --' y ces. State laws, and sand regulations the San.Jaauin Local Hth District. ordinances. (Ow er.and/or Contracto 1.9 - ----- --- (Signed) _ ---- (Sr ned - ( . + 9 --- ----- -- ----- ------ By: �------ - --------------�----------------------(rale}-------�-�- --- ----- ----- ' -- _ ,"_ (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverseside}. FOR DEPARTMENT USE ONLY 5 APPLICATION ACCEPTED BY______________________ DATE- -Y,;--.-T -------- DATE'---------- ` REVIEWEDBY--------------------------------------- -- I --- -------- -- - -----------�--------- DATE--------------------------------------- - --------------- BUILDING PERMIT ISSUED------------------------ -------------------------------------------------- 1 Alterations and/or recommend ations---------------------------------/ \J -- ------•--------- -•-----------•----•-------------------------- _?__q--------------r---------------------- --- --------------------------------------------------------- ----- - ---------- I --------- -------------------------------- - ? R ---------- -------------- ----- ----- ---- --------------------------- ------------------------ 5 ______________ ---- Date---- ----- - -------------- FINAL INSPECTION BY.._ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street 130 South American•5treef 300 West Oak Street Y Tracy, California Stockton, California Lodi, California Manteca, California Y' ES-4-2M Revised 1.57 F.P.CO.