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F FICE USE: fC, �- �'a f- -- ---- Permit No. -- ---• - •---- APPLICATION FOR SANITATION PERM17 --------------------------------------------------------- (Complete in Duplicate} C� ---- Date Issued _-__-- � + / ------------------------ -- This Permit Expires 1 Year From Date Issued 'Son Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the This application is made in compliance with County O inarL e No. 549. �-G -- ---• --------------------------------------------------•---------- ---------------- JOB ADDRESS A LO ATIO Owner's Name------- _ _ ------------------•----•--- •-----•-----•-------•-----•-----•------ -- Address r �/� ...[ �,,(� � Phone. __ Contractor's Name-Q�t�4.-�_ ay� f.' ! p4 f- f l Motel Other ❑ Installation will serve: Residence Apartment House ❑Commercial ❑ Trailer Court ❑ ❑ T-1 ` X-0* .'Number of living units: -_�_-- Number of bedrooms _YNumber of hs ---/__ Lot Public system Community system ❑ Private Depth to Water Table -------- ft. Water Supply: Pub y ❑ Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe Hardpan ❑ # I ' , No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ Previous Application Made: (If yes,date._--_---- ❑ � l TYPE OF INSTALLATION AND .SPECIFICATIONS: (No septic tank'oi cessPobl permitted,if public sewer is av t18b]e within 2I ee#. y e n ; f 4Distance from nearest we -- Distance from foundation-------------------.Material____._.__.________.______________.___-.____.___. . t No. of compartments----- - = -Size--- --•------------------------Liquid dept Capacity. � ` -' s ,ed: Distance from nearest well�l �enath ofeach line-4 at � ' _ Q'stance to nearest lot line ti . ____.Width of trench Number of lines----�---- --- ----- ---- - -Lengthr 1�!! Total length..--- De th.of filter.mat riaL_______ ____ ____ Type of filter material S - P l ! O Distance'from foundation--------------------Distance to.nearest lot line_____.________... - - Seepage Pit: Distance to nearest well--------------- s Number of pits--------- ------------Lining material_------------- -=..Size:.Diameter--- Depth t b l .Yd�A❑Y ~ _ •Cesspool: Distance from nearest well-----------------Distance from foundation'-'.____.____.._..Lining material__.____.______.----- als,` --De th-------------- ------------------------------------Liquid Capacity------------------ -----9 ❑ Size: Diameter----- ---------- ------ - p '1 Distance-from nearest building__ Privy: , Distance from nearest well---------------------- R . 3 " ` Distance to nearest lot ine_-------------------------------------------------------------------- ❑ + •� t . Remodeling and/or repairing. (describe)-------- --------- ------------------------------------•------------------ o4 5 . --------------------------------------- - --------------------------------------------------------- f - --------------------------- - --------- ________________________________________,____- M _._._____. r - ..+N .___ -i-- i --------------------------- = ---- , --------------- I hereby certifytliat Lhaye,pTepared this applic io an JoaauinhLocal kHealth eD'oric}. accordance ith San Joaquin County regulations of the qo ordinances, State,law , and rules and g 1 � actor)or) .. ontr (Signed)_ ; ------ j I- ------- ., - -- it a ----- --- --•---------------------- �.._. -.._ : bY'•----�--------•----'- buildings, et , can be placed on reverse side). (Plot clan, showing size of lot, location of system in relation to w Is, i FOR DEPARTMENT USE ONLY � ,. . / DATE---3I __� --------------- i i APPLICATION ACCEPTED BY- - ----- =t--------------------- = ------ ----------= DATE REVII WED BY r ---------------------DATE----------------- == BUILDING PERMIT ISSUED------------- --- --`---'-# --------- --------- --- f!Ies� ------------- A •--- --Aions and/or recommendations----------- ---------.-.-------- --------------------- ------------- ---------- ----------------------------- --- ----- --- ----------- ---------------- -------- --------------------------------------------------- - - - - --------------------------- -- --- - - - ---- --- ----- ------ -- .w. y Date- - --� FINAL INSPECTION BY�=---- SAN JOAQUIN LOCAL. HEALTH DISTRI T 1601 E.,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1 ES 9 REVISED B-59 3M 3-'63 G.P.C .