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APPLICATION FOR SANITATION'PERMIT Permit No. __l��L..---_.. + (Complete in Duplicate) Date Issued ------- - -��l� -- ------------- I Health District for a permit to construct and install the work herein described. �Applicaaion is hereby made to the San Joaquin Loca This application i� made in compliance with County Ordinance No. 549. any - JOB ADDRESS AND OCATION_..---•--------- ------ ------- Phone------------------------------------ Owner's Name----_--- ---------- �r Address `r`S a --------- --------------•-------- y -----•- - ----- ----------------- Phone /J�� G/ Contractor's ame----------- ___ t -------------------- l ommerciaTrailer Court [I ,'Motel ❑ Other El9Ly Installation will serve: Residence Partment House ❑ C ❑ sNumber of living units: __/__ Number of bedrooms __ " Number of baths -•�--- Lot_size __- -_- --� Water Supply: Public system �Communit system Private ❑ Depth to Water Table ----- f+• PP Y� Y Y ❑ 0 Gravel ElSandy Loam ❑ Clay Loarri❑ Clay E] Adobe Hardpan ❑ Character of soil to a depth of 3 feet:` Sand Previous Application Made: Yes ❑ Naew Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: ~ (No septic tank or cesspool permitted if public sewer is available within ion feet.) l . nk; Distance from nearest well--------------�-Distance from founda+ion--.----------------Material--------------- ---- ________________4��/ No. of compartments------------------------Size---------------------------=---Liquid depth---------- f--------------Capacity o a geld: Distance from nearest well----------------- _Distance of from e each line 8fion.-------.- -W afihtofttre chest lot line------------------------ ---------- Number of lines- , Type of filter material------------------{"--- .Depth of filter material----------------�----Total' length--__•----------•---------•--------•----•-- s��-- Distance from foundation_.- m.._.__.__.Distance to nearest lot line______�Z- --� Seepage t: Distance to nearest well7! ` -; �� __Linin material- _:.��- Size: Diameter---j-Z...-------Dept'n_.__ 5------------•--------- Number of pits__.__-�---- ---- _ 9 ing Cesspool: Distance from nearest well____ -..___-._-Distance from foundation-_----- -- Linuid Capacity gals. Size: Diameter---------=--------------i-------------Depth----------------------------- ----- q p Y---------------------------- Distance from nearest well____---------------------- -------------------Distance from nearest building----------------------------- ---------- Privy: ----------------------- Distance to nearest of ine__________________________ _�- I ----------------- Remodeling and/or repairing (describe):_____ _______________ -- --------- I hereby cerfify that 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 the San Joaquin Local Health District. ---- --- (Ow and/or Contractor) .ner a d/o C actor Si ned - -- � � j . t -� - (r+I - ------ ---------------- (Plo+ plan, showing size of lot, location of syern relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY -------------- --------------------------------------- DATE- ---------- ------------------------------•------ APPL1CATlON ACCEPTED BY -- DATE__ 0 ------------------------------------------------- REVIEWEDBY - -------------------------------------------------------- BU I LDING PERMIT ISSUED------------------------------------------- -- ------------ ------------ ----------------- DATE----- lt!%---_.----------------------------------------- Alterations and/or recommendations:-________-._.______________________ - -------------------- --------------------------------------------------- ----------------------------------- i--------------------- ------ I Date---- -----?-- - ------------ FINAL INSPECTION BY:.--- -- --------------------- - --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 614 North "C" Street 130 South American Street Manteca. California Tracy, California Stockton, California ,Lodi, California E5-4-1M Revised W-2100'