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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ----_-` _ (Complete in Duplicate) Date Issued . _�__ -'47 . This Permit Expires 1 Year From Date Issued ------- ----- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d �cri ed. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LO ATION_1jf - j � f' { �-f- 7"'�� y' + = ------------------- Phone Owners Nawme- = -----.=- Address------ r -•---- f� ------ .17 �- Contractor's Name -------- -------- ----------------------------- --- Phone_.. h ' � Motel Other .Installation will serve: Residence J artmenfi House ❑ Commercial ❑ Trailer Court ❑ ❑ ❑ f _" ---------------- 'Number of living units: -_/�__.Number of bedrooms __��__-__ Number of baths ____-_._ Lot size _�_ � ., 9 ft. Water Supply: Public system ❑� Co unity system ❑_ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravels❑ Sandy Loam ❑ Clay Loam ❑ Clay [Adobe❑ Hardpan / FHA VA: Yes No Previous Application Made: {If yes,date __- -_-. ,._._,---_l No ❑ NewC onstruction� Yes ❑ No ❑ / ❑ F, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic•tank or cesspool permitted if public sewer is available within 200 feet.) 4' Se pfic Tank: Distance from nearest well__._-_.____..___Distance from foundation_"-'______________"..Material---_...___"._.____..."_.._.______-..-_- -,/ Liquid de th---------- Capacity �� No. of compart�nts-------------------------- .ale--------'------•-------------- q .. p �, � foundation--9;V to nearest lot line_:- .... Disposal Fi ld: " Distance from nearest well-/.4-1Distance from foundation_ "___ ------Width of trench._"-- 11 I Numbof of linmaterial _ Length of each line__-- it i a ype - _ 7 ZsZce of filter material--/ _ _-/"--Total length__' ---=--------------- f- 4 r s t /< Dista��e to nearest lot lin Seepage Pit: Distance to nearest w:eI4--. �-."--. from fou dation___P-24' — =" f Number,of pits.----/----`--------Lining material : P Cesspool: Distance from nearest wel ._ _.__-__Distance from foundation------------------- material.---____....-..._________._-___.._� l _ _ ❑ Size: Diameter-.-�_f__�--------------No`�_ Depth----- - -- -_"-"---Distance from nea�estlbui dapgcity---------------------------gal��. Privy: Distance from nearest well._---_._._--_---------------------- ❑ Distance to nearest lot line------------------- I � --------------------------------- - e aiiing (describe)------- =Remodeling and/or r il I ---------- ------------=----- = f I -------- -- ------------------------------------------------- '` --------------------- -------------------------------------- ----------------------- ------------------------- I hereby certify tha# i have prepareld this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an'd4egulations of the!San Joaquin Local Health Distriet. , -i+Qw.n" or Contractor) $i Heid -------- c ---- °=------ (Title) i - :.-.... (Plot plan, showing size of lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -- DATE-47-71-P-16-7 ----- -- tAPPLICATION ACCEPTED BY-._._- -_ -"-------"---"- - �`' REVIEWEDBY.------------------------------------------- - - -----------------------------------•------------------------------------ DATE - : BUILDINGPERMIT ISSUED---------------------------------------------- ------------------------------------------------------.. DATE Alterations and/or recommendations:__r................. ------`---•--"--"-•---""--•--"----------""--"------------- ------------------------- fi i -- �1/--------------------- ---------------------'- ---------- -._ a - Date FINAL INSPECTION BY:.� SAN JOAQUIN'L�CAL HEALTH DISTRICT- , 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California ."' Manteca,California Tracy,California F.P.CC7.