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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is 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. 549. k7 JOB ADDRESS AND LOCATION__.101 &S ---tz Phone..,F P,9 e. Owner s ----- /----------------------------------------------------------- Aciclress54_ ----------- Phone--_ --- ---- ------ -------------------------------------------------------- Contractor's Name--------------------------------- Motel 0 Other El Installation will serve- Residence 9 Apartment House [I Commercial E] Trailer Court I 'Nu om,,3--- Number of baths 1-4-Act Size ------------------ iving units: JV Number of bedrooms__. ft. Number of I Private X Depth to Water ._ I Water Supply: Public system F1 Community system 0 Sandy Loam El Clay Loam Clay E] Adobe Hardpan [I Character of soil to a depth of 3 feet: Sand F-1 Gravel [I Previous Application Made: Yes [-I No* New Construction: Yes J� No n TYPE OF INSTALLATION AND SPECIFICATIONS; available within 200 feet.) (No septic tank or cesspool permitted if ublic sewer is )n/0�7 Material--------- -------------- -------- ------L.T------ Septic Tank: Distance from ne-.--. _Q______._.Distance from foundatic ------- C � -Size5%",4-J., __ q d - -------Capacity-/-P-1------ Z 6....... Li uid ep�btrxf _ No. of compartmenfs--, i ne-45-7 -- Disposal Field: Distance from nearest welltplo--------Distance from foundation" -- Distance to nearest lot �i each line-----I Width of trench ----------------- m - ' lines-1-1 1 4-------------Length of 7_5�---------------- A 01 filter i ter ma ---------! __ a----- -----_Total length-- - ---- ----------- Nu Number o filter materi'l 7x- Type terial-_ - 5----IZA----Depth of fiLlt foundation_ nearest lot line Q5 Seepage Pit: Distance to nearest well/C)& ---------Distance f rQm - --- -------Distance to --------------- Number of pits.1--------------------Lining material C-_(461V3- __.-Size: Diameter----A1.7-------------Depfh.=V- ---------------- X_ _L� from foundation------------------- Lining material--------r------------------------------ Cess,ool: Distance from nearest well-----------------Distance -----gals. p -------------------Liquid Capacify_------- ------------- ❑ Sizt�: Diameter-_-:---------------------------- ----Depth-----------•------------------- i Distance 'Irorn nearest well------------------- ----------------I------------Distance from nearest building------------:------------------------ --- Privy: k ----------- Distance to nearest lot line------- -------------------------------------- ------------------------ -------- ❑ _f, -------------------------------------- Remocleling and/or repairing (describe):--- ----- --------------------------------------------------------------------------- ----------------------------------------------------------------------11-------- ---------------------------•-------•--------------------------------i --------I-------- -------------- ---------------------------------------------- -------------------------------------- _____L------------------------------------------------------- -------------- -------- ------------------ ---------------- .................... --------------- ----------------------------------------------- --------- I __1:--------I-------I-----------------------------------I ----------------------------------- -------------------------------------------- ill be done in accordance with San Joaquin County I herobf-c-e-_ ec uin Local Health District. ,Yrfi�!ys hat I have pr�' red this application and that the work w law and rules regulations of the San Joaq ordinances, S tate la Contractor) (Signe d)........... ---------- (Title)- __P------------- ---------- --------------- By:--------------------------------- (Plot plan, showing size ---------------------- of lot, location of system in rel ton to wells, buil 95, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ACCEPTED 13Y ------ ----------------------------------------- -------------------------------------------- DATE_ --- ;------- ----------------------------- APPLICATION ACC ---------------------------------- DATE---4-t`----------------------------------------- REVIEWED BY------------------------------ ATE. - ----------------------------------------------- - _t----------------------- ------------------------ DATE-------ry BUILDINGPERMIT ISSUED-------- --------------- ----------- --------- ---------------------------------------------------------------------------------------- Alterations and/or recommendations -------------------- ------- ------------------------------- ----------------- ----...-•----•---••-----•----•--------__"_-- ------------------- --------------------------------------------------------- ----------------- --------I-- ---------------------------- ------------------- . -----------------------------------------------------------------------I----------------- ------------------------- ---------------- ----------------------------------------------- -------------------- --------- ---------------- --------------------------------- ------------------------------ ----------------- ------------------------------I------- --------------------- --------------------------------------------------- ---------------- ---------------- --- ----- ---------------- --- ---- ------------------------ -------------------------------- -------------------------- ------------------------ - --- - Date..-------- ........ ------------------- FINAL INSPECTION BY:----------------- ir------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S 130 South American Street 300 West Oak Street Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M i0-52 Revised W-2100