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FOR OFFICE USE: Permit No. ------------------"----- ----- -- APPLICATION FOR SANITATION PERMIT ------- ---- ------ ----------- - (Complete-in Duplicate) Date,.lssued " ----- ------------1------ ---- This Permit Expires it Year From Date Issued OSS, 2-(o -------- ------------------------------------------ -- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. o ► -JOB ADDRESS AN OCATION _ �--- --------• ------.---- -- - i Owners Name- --•------ --------------••--•- i Address ------• = a ---- Phone---------------------------------- Contractor's Name-------------- ----- motel [3Other ❑.."' + r Commercial E] Trailer Court ❑ Installation will serve: Residence Apartment House ❑ Number of living units: Number of bedrooms Number f baths__ - Lot size I, Private-Depth to ater Table 4.-a- ft 1- Water Supply: Public system ❑ Community system ❑ Adobe Hardpan Gravel Sand Loam Clay Loam ❑ Clay ❑ ❑ ❑ " Character of soil to a depth of 3 feet- Sand ❑ ❑ y No FHA/VA: Yes ❑ New Construction: Yes ❑ ❑ �y Previous Application Made: {If yes,date_....--.---:----- - I No ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tanVor cesspool permitted if public sewer is available within 200 feet.) Septic an k: Distance from nearest well--- �- --Distan e ram f unda4o _-.-��--------.Maters �.-. ' ✓ ` O No. of compartments-._� -- Size / ![ ` -L quid depth Capacity/-a I --- Q_"..-.....Distance to nearest lot lin ---• Dispos Field: Distance from nearest well. -_. Distance from foundation- 4 Number of"lines 1_"-_. r.. -- Length of each line_749__--'- __ Width of trench ----------------- -"---_..Total len th-- -.�Q----------------------------- Type - - - Type of filter material_.-.��--�- --Depth of filter material-____`�- - 9 �- --- --- -- -- """--`""-"�-------- t Seepage Pit: ,Distance to nearest well----------------------Distance from foundation---------------------- to nearest lot lin e--._----_-.-_-.-- t ❑ :�Number of pits--- ------------------Lining material-- --------------- Size: Diameter--- ------------- Depth-------- ---------------------- Cesspool: ,.Distance from:rnearest well _-. Depth-.--.tfrom foundation.._ -_ :--__--:Liiquid Capacity-.._-------- --_---------gals• t ❑ Size: Diameter" -- - ----- •� u -------- ------ `Distance from nearest building----------------------------------:- Distance from nearest ,7-elly.:-.----__"............. ... Privy: ---- ------------------------ --- -------- --- t ❑ Distance to nearest lot line .-.--_------------------- Remodeling and/or repairing (de�crilae)--------------_..---------------------- - _ - -1 ---------_--.~--------------------------- -------- -------- ----------------------------------------------- ------------------•-------------------- ---------------------------------------------------- I hereby cert' that I have prepared this application and that the work-will be done in accordance with San Joaquin County ordinances, Stat la s, and rules and reg ions of the San Joaquin Local Health District. I N nd/or Contractor) ------------- Si ned -------------- ----------- --- -------- -------- �Y� r ----- ---- - ----- - { :.: _itle) �- (Plot plan; showinta siie`of Iot;�locatio o sys+'�em in ation to wells,�buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _. DATE ..-._.:. --- -------------- - APPLICATION ACCEPTED BY--_. -_ -- ---- -- -- -- •-.. DATE ----- ------------------- ---------------------- REVIEWED BY------------------------------------------ -...__ - - ------------------------ ------------------- " ------------------ • - • DATE---------------- -------------- ----- ------------------ -- BUILDING PERMIT ISSUED-------- -- ---------- ------ --------- --- ---—---- "-------- =------- ----• --------------- - ..- -----.-,.. - Alterations and/or recommendations - v _. T- -----------------------------, . --- ---------------- K . j-.-. _ ------------------- ------------------ ---"..--_ 4 _- FINAL INSPECTION BY:.----_-_- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stoeklon,California Lodi. California Manteca,California Tracy,California i E.H.9 2M 1.67 Vanguard Press