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FOR OFFICE U E: ,; ,•� Permit No. APPLICATION FOR SANITATION PERMIT - ----- -- f------------------------ 'Z- �-- (Complete in Duplicate) t Date Issued __�a. ./ ---- Y�. ----------------- This Permit Ex ires 1 Year From Date Issued ----------- Application is hereby made to the San Joaquin Local Health Disfiricfi for a permit to construct and install the work�herein described. . This application is made in compliance with County Ordinance No. 549. ` ------------------------------------------------------------------ JOB ----- -- ------•----•------•-•--------------•---- JOB ADDRESS AND LOCATION.................. --------- Phone-----•--------•.............. 12,194 Owners Name------------•---------•---•-•------- ' ------------------ t - / ------•----------- Address.- moi [-- �..----•--• • --•� •----- Phone __. t Contractor's Name l•------------- Motel Other ❑ Installation will serve: Residence Apartment House ❑ Comrnercial ❑ Trailer Court ❑ ❑� Number of living units: .,) __. Number of bedrooms --yE-•• Number of baths ---I--- Lot size ___�D- --f�-= Private ❑ Depth To Water Table _. a ft. Water Supply: Public system Community system ❑ Y ❑ Adobe[5—Hardpan ❑ W Gravel San Loam ❑ Clay Loam la Character of soil to a depth of 3 feet: Sand ❑ 0� FHA/VA: Yes ❑ No Previous Application Made: (If yes,date--------------------) No New Construction: Yes 7 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T Distance from nearest well____-------•Distance from foundation__.1.0------------Material__.____ ------ ••------• Septic ----.-Ca au ` ---Size__ Li uid de th p #Y �. R No. of compartments____._.---,------ ---3--��•' -`-" q . ---Distance t lot Disposal ield: Distance from nearest well------�-----.-Distanofce ro h line---- ---- n ati��Q --• --.Width oftfrench85-�5' aine----------------- Number of lines ! �-� ---------.Lengthr Type of filter material...-/-. _G ------Depth of filter material___--2' ------------Total Leng#h____ _0_-------------------- 6 Seepa Pit: Distance to nearest well.__-��-.------Distance from foundation__ .....e---_.Distance to nearest lot line LS-._.-•••--••- i i Size: Diameter -3'3 Dept h....:. Number of pits-�----�-----------Lining material.--__�r�.Gdr- - =- ing Cesspool: Distance from nearest well-----------------Distance from foundation-----------•---•---'Liquid Capacity material gals. Depth.--------------------------•-- - - Q p ----•--• ----•----- � ❑ ; Size: Diameter---------------------------- --------- Privy: Distance from nearest well-------------------------- -- ------------------Distance from nearest buildin -------------------------------- ------------------ --------- ❑ Distance to nearest lot line------------------------------------------------------ 0 f• k I 1 # ---------------- Remodeling and/or repairing (describe):-_____-_____________-- -------•------------•-----'•4----------------------------------------------------------------•-------------------------------- -----------•_____.______•_.. ___._- I _____________________________ _______________________ -----------........... done I hereby certify that I havesPandaredulat ons olicahen andthat Joaqum Localwork Heawill ltheDi trictn accordance with San Joaquin County t ordinances. State laws. and rul 9 - -- - -- --'---- (Owner and/or Contractor) (Signed ) Tt+le --- --- -- ------------------------- { (Plot plan, showing sire of lot, location of system in relation, o wells, buildings, etc., can be place an reverse st e. l R DEPARTMENT USE ONLY I DATE_.. 1 .1 -- APPLICATION ACCEPTED BY_..--i------ ---- ------ ----