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FOR OFFICE USE: ► JJ Permit No. S--•••••• -a ,-� 'APPLICATION FOR SANITATION PERMIT • --•--- •- ••--- -" "---- .. "-- � (Complete in Duplicate) Date issued ..................•. --- This Permit Ex ires 1 Year From Date issued ................. - A Application is hereby made to the San Joaquin Local Health District for"a`permit to construct and install the work herein described. PP 47. This application is made In compliance with County Ordinance �, i. JOB ADDRESS AN LO VT N____-- ."-- -- -.�--------- 4� -.•-"" Phon11! e - -•--��--��-�`•�r-�-F"" .-........................... 1-0 Owners Name_..__ _.Y.-" -- �r ` �0• Address. --- ................................... one.. y��/L ---------------------- Ph t •---- Motel ❑ Other Contractor's Name---- ___ - "- Trailer Court Installation will serve: Residence Apartment House ❑ Commerual ❑ ___ Number of bedrooms - Number.of baths i/---- Lot size . Number of living units: _� t r th ro Water Table - ft. Community system ❑ Private �eP 1 Adobe Hardpan ❑� Water Supply:, Public system ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ t �, Character of soil to a depth of 3 feet:( Sand ❑ New Construction: Yes ❑ No FHA/VA: Yes [I No El C i ) No Previous Application Made: llf yes,dote_._.. TYPE OF {NSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F f - ' w p}i ank': Distance from nearest well-----------------Distance from foundation......_.---•--••=--•Matarial.._--_.__-•--•• ...... .."•"'•-_- Size---••--•--•---- ----------Liquid depth-------- -.�.....Capacity I No. of compartments...__- _._..- �.-- Distance to nearest lot line................. ',• a ;..s -- �i os ld: Distance from nearest ell.: Distance of re each line.om �}1On-=•+�Q-- _Width of trench__..____.-�- -------- i Number of lines.-"-•---• - Total length-- ---.--•-----•----------•- ••.... r �- � " k f Type of filter materia__._ /.. _ . '- . Depth of.filter ter material._....___-•"_---�-• Seepage Pit: Distance to nearest well (�--.._._..Distant m foundation_._n.� Distanceto nearest lot line..._-----•-•- ` Size: Diameter_.._.--c7....._...Depth_....... Z7,0 ---••--••••••. Number of pits!.... . _ Lining matdrial_ _ .D�/r 1 1 Distance from nearest well-------------- from foundation--------f---... Liquid Capacity gals. Cesspool: q • Size: Diameter.!-----`............................Dept --------•-----•------- ---------- .. 0 "•--_• "..•_•..............Disfiance from nearest building_.......____-..-----•--••------•-••--••- I Privy: Distance from'nearest well--- _ . — - ❑ ; ...... . _ Distance to nearest oine. .__.. .............-•- y1 Remodeling and/or repairing (describe):-----------------------------------------------.....--•-------•----- .--..•.•................... 1 •, ......-•.......---••---•...• ------•------••-----..._. .....- that Ihavety -••---"----•---•---- d that -- will.will done-- I hereby y es pr dared let ons application the San J Joaquin hLocal kHeal Health n accordance with San Joequtn oun ordinances, to aws, ander I i` ....--_...•-•-------(Owner and/or Contractor (Signed) -- --- •(Tit! -------------------------•-- - By:.....;-•-•--•.................... `_'"_..-.. _ buildings, etc., can be placedonreverse side}. (plot plan, showing size of lot, location of system in le+ion to wells; ` FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY -- -- DATE......'................................................................ REVIEWED BY_..........-------- ----------------------------- ---------- ..._..... - DATE............... BUILDING PERMIT ISSUED------------------------------- ---------- Iz, 11- 'r'..G_ ,•• ..... Alterations and/or recommencrations:____ f---�✓� "" d ............................... 1 .......................-............................................•... -----------------•--••-•-•-•-..._........-•-•-----..-_.............................................................................. •••-- .. � ........... Date...--. - FINAL INSPECTION BY-.Iv/g. . ........................... SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak it»N 124 sycamore Street 205 West 9th Street 130 South American Street Manteca,California Tracy,California Stockton,California Lodi,California �c ❑ ocvi5FD 8.59 2M 5.62 ATLAS