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OFFICE USE: FOR ``"" ---- Permit No. __ ../_._ ...., -------------------------------------- APPLICATION FOR SANITATION PERMIT ------ ------------------ (Complete in Duplicate) Date Issued ------------ -------- --------------------------------- This'Permit Ex ires 1 Year_From Date Issued - Application - hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544- • �i JOB ADDRESS AND LOCATION.. _ ---------'/'1G�• L- ------± --_-- -- ---•-------•--------- ----------•------------- •--------•------- ••- r - Phone----------------•---- j ------------- Owners Name----- Address-------- /6 - =` one ---- =------- ---------------- ---------- ---------•----------------- ----- P Contractor's Name------__-��74r- Motel Other ❑ Installation will serve: Residence �Apartment�House [I,--Commercial'❑ TTrailer Court ❑ �le ❑ 01 I -•------ Number of living units: _-�.--_Numb'e�of bedrooms ___ Number of-baths _Z--. .Lof size _ p__�Ji!_� r�•- Water Supply: Public system: ❑,- Community system [� Frivate ❑ Depth #o Water Table . lt- ft• � PP Y� .. __ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay 'Loam ❑ Clay ❑ Adobe Hardpan ❑ i - FFiA/VA: Yes [� No ❑ Previous Application Made: (If yes,date----------------- ) No New Construction: Yes go'No ❑ } TYPE OF INSTALLATION AND SPECIFICATIONS: a ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,M �'! Se tic Tank: .Distance from ntsarest well-_-_�:__----Distance f�om foundtion__-_. -_.: ,: a ri�L-�c--e-14___--'__ --------------- 'from - J--------- Septic ------ ... _ ; size : Q p _ } No. of compartments------ _.--- >r��__?�-�----.Liquid de th:_.�tw------------- -Capacity-- -� �' Disposal Field: Distance from nearest well--_' '____---:Distance from foundation----1?---------Distance to nearest lot line__------- ��`�- -----------Width of trench---, ------------------------ Number ----------- ------- - t Number of lines---------vZ- 1---- ----------Length of each line____-_--_ _____ �* Type of filter mater -tX1l.Fe-Depth of filter material- Seepage - -----Total length.-_-- as_d----------------,•-'--- Seepage Pit: Distance to nearest well_----.—----------Distance from foundation----- ---------Distance to nearest lot line._47_-____.. C Depth_�*�------•--------------- \ Number of pits_-__._ ___-___--Lining material Diameter---- ---------------- - Cesspool: Distance from nearest well----------------'Distance from efoundation--------------------Lining material----.-_--------------_--------_------ Depth ------- ------Liquid Capacity ' -------------gals, Size: Diameter---------------------❑ . \ Distance from nearest well = -- " 'Distance from nearesf building------------------------------------------- -------------------------- -------------------- Privy-. i .. --` --------- ------------------ ❑ Distance to nearest lotline_:�------'------'--------'-------- --------'- ------- q 4 Remodeling and/or repairing (describe).---------------4 dA0----S410lez �� ' -------------------------------•----•---------------------------- ti1 -------------------------- ------------------------ ~_--_--. ia .. ------------------------------•-_-_-_----_--_-_----_------_..----•_--------_-• ,---_--- l _ ----------------------------------•--------------------•------------:--_-_----_••_�-------------F---.---_- __••-----_---•• _--___-----------•-----.--------_----_- . .., wvr - i I hereby certifytliat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of theSan Joaquin.Lacai Health District.. ; (Signed) `'Q _ _i ;,es-e'r ------ f (Q =n} or' Cokra -� ------�---- --------------------------(Title-- By:-----------------------------------------•-•---- =---------------- _ . I (Plot plan, showing size of lot, location of syste n-re tion to wells, buildings, etc., can ba placed on reverse side). # FOR DEPARTMENT US ONLY F -------:-_-I.ATE-_,+7=_j C7-�- ----.. APPLkCATION ACCEPTED BY--- -- ' +�--r -- --��'�-�- -- `-`�`------_—.-----`�---_ - ------------------------------- DATE. REVIEWED BY-------------' - DATE-------------------- BUILDING PERMIT ISSUED------;-------------E-------------------;------------------------- , �._ ---- Alterations and/or recommendations:--------------------------. _ ---------------------- ---------------------------- ---_•_--- --- .r __•------- - - --- - ---- Date-•-....... -(------------------------------------ FINAL INSPECTION BY-..'-- SAN JOAQUIN L6CAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Locil,California Manteca;Callfornia Tracy,California Stockton,California fe' EB-9 pEVl6 E0 0.59 F,P.0 a.YM 6.6C