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FOR OFF OUSE: lPermit No. ..-..�--3�•... APPLICATION FOR SANITATION PERMIT �j• ' -----------------V----- ' {Complete in Duplicate) Date Issued __.-7.._.�.-----•-- ------------------- --------- This permit Ex_ires 1 Year From Date issued ----------- -- v Application is herebymade 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 ounty Ordinance No. 549. tt 1 L -------- . ---- ...... JOB ADDRESS AND OCATION....l-r----------------- Phone-.I / -------------- ---------------------- s . "4'` �D m -------•- ----•-------•- Owners Name---. =�" � Address9 ---------------- ----=--• ------------------•--------•-----------------------•--- ► Phone -.---•-- I Contractor's Name----- .-•------------------------ -_. _ _ - •--- Motel C] Other ❑ I Installation will 'serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ `Numberiof living units: _--I_-_ Number of bedrooms __ -. Number of baths _,l-._„ Lot size _7 y2 S f ------- e . , P_- ft. Water Supply:-Public systemCommunity system ❑ Private ❑ Depth to Water Table Adobe�ardpan C]Character of soil to a depth of 3 fe Previous Application Ma1 Yet: Sand E] Gravel ❑ S ndy Loam ❑ Clay Loam ❑ Clay (3de: If es,date----- -----------) No New Construction: Yes t ado ❑ FHA/VA: Yes ElNo TYPE OF INSTALLATION'AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. _Distance from foundation.._0--.-_--.---.Material_- ---------------;,-- -�r.� Septic nk: Distance from nearest well r Ca acit p�U .- No. ofcompartments--------- --------- Size. - -_ ._°l Liquid depfih = p Y ¢ � Dispos Field: Distance from nearest well.- ----_-.Distance from foundation--/_d--------------Distance to nearest 1 zl -- ::_• ________________Length of each line----_--7� ----------------Width of trench--.____.__ \ Number of lines----- ----- g .Total length 15 ------------------- Type -•--------- Type of filter material-._-- --------Depth of filter material___ _ _____________ g , Distance to nearest lot line_-------------- Seepage Pit: Distance to nearest well----- -.___-_Distance from foundation_- amete�---. De th___.-.,2r---------------•- ( �/ Number of pits---- --.--- ---Lining material------------ -----___.Size: Diameter_-- _- ._- p ----------------------------------- __ Lining material-- -----_---__--------------- Distance from nearest well------------- Distance from foundation_ ------------ ---------------• gals.Size: Diameter ------------------------Depth----•---------------------•----- -------- --------Liquid Capacity-------• ❑ , n .� � . Privy: Distance from nearest well__________________77 ----------=Distance from-nearest building \ ❑ Distan�a to nearest lot line--------------------------------------------------------------- ---------------- Remodeling and/or repairing (describe)- -------------------------------------- Y - ------------------------------«__--__---..----___---._-_._---._ ---------•---------- _--_--___._ _______________________________ I hereby certify that"I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances; State laws, and rules and regulations of the San Joaquin Local Health District. i (Owner and/or Contractor( (Signed) -------- ------------------------------------------ --------------------------------(rte)---------- -------- -----•------ -- i By---------------- = ---------------------- --- (Plot plan, showing size of lot, location of a 'in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ~ --------------��-`---�-------------•----• ----------- DATE------2_.--�_C�----�-•--- I------------ REVIEWED BY---------------- --------------- ------------------ ------------------------------- -----------=----- DATE-.. DATE BUILDINGPERMIT ISSUED------------ ---------------------------- ------------------------ - ---------------- (-----------------------------------------------and/or recommendations:-_______ - -----, --•----- -- � . _ � - - --------------------------- - .mfr-��-- - -- ---- - --. .�. °'-- ---�- ri �C fir'« y . - --- - •- __------------------- ' �.... _ Date.-------�.---- - - ✓ -3 ---------------- ------- FINAL INSPECTION 36Y:__----. -�`.--- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wait Oak Street 124 Sycamore Street 205 West 9th Street 130 South American Street Trae California Stockton,California Lodi,California Manteca,California Y, 4 E13•9 REVISCO 13.59 F.P.CC.yM"n