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Permit No. .___� -IR--Y---- APPLICATION FOR SANITATION PERMIT _ n (Com /_�.� , 4U + plete in Duplicate) pate Issued --------- ------- 1 1 Application is hereby made oto the.San JoaquinLocalHdenllt[h DIIce toc for a permit to construct and install the work herein described. This application is ma9. de in oompliance with County a - --- JOB ADDRESS AND LOCATION 0 - - �� _ J j� / ,� / Phone- ", Owner's NameQL�-1s -,1�]' -1.1.--V- /-�/ ------- -------------------------••-------- Address------- --------•-- �I Phone--------�- --------�- ---••- Contractor's Name---.- f Motel Other ❑ Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court [I ❑ Number of baths _/_ _-- Lot size _--_�D_----�---+1-��----- --- Number of living units:(,}�Number of bedrooms __ ____- -__ ft. Water Supply: Public system � Community system '❑ Private ❑ Depth to Water Table Character of soil to a deptofeF-1Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [IC depth 3 feet- Sand {V,,1 Previous Application Made: Yes ❑ No �( New Construction: Yes ❑ No t -` TYPE OF INSTALLATION AND SPECIFICATIONS: (A (No septic tank or cesspool permitted if public sewer is available within 200 feet.): eet.) ' Septic Tank: Distance from nearest well-----------------Distance from foundation_ { -de depth Materia --------------------------------Capacity__-___--_____________ ❑ No. of compartments--------------------------Size---------------------------------- q P Disposal Field: Distance from nearest well - Distance from line foundation--------------------W dthcoftfrenchest lot line----------------- Disposal Number of lines------------------------------ TYpe of filter material Depth of aterial----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well_ 4 -_____-Dist ce fr m dation__ fJ --------Distance to nearest lot line-"------- Linin matQrial__Rvu�_ -Size: Diameter__rf�- lA� Depth_- -----Number of pits- !-- gCesspool: Distance from nearest well-__- ____-__"___Dice fr oundation-- ---_--"_-^-- Lining quid Capacity_: gals._t ❑ Size: Diameter----_----------------------------------Depth-------- Distance from nearest buUing------------------------------------------ Privy: Distance from nearest well--------------------------- ---____-_---- ❑ - Distance to nearest lot line_____________.------" --- .4 , i -- -------- ------ -- -------------- Remodeling and/or repairing (describe):------- --- 1 - ---------------------------------------------------------------------- - oa I hereby certify that I have prepared --�his application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and regulbtions of the San Joaqui Local Health District. �.... . G ( SO -. lC_- „�r( w 9dContractor) t ne Contra or] (Signed)------------- `• r ------(Title) K By:- --------- tion of system (Plot plan, showing size of lot, locam in relati� to wells, buildings, etc., can be placed reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-_____-"________-�-}� l / -� --- ------------------ DATE---X " �,/ / ------- ------- ------ DATE-------X------------------------------------------ REVIEWED ,BY------------------- -------------------------------------- } BUILDING PERMIT ISSUED----------------------------------------------------------- - -- -- Alterations and/or recommendations:-_ ---------------------------------------- --- ----- ---------- ----- � ;' ------------ ---------------- ---------------------------------- ---------------------- �is --------------------- ------- � -- ��. ----------------------------------------------------- -�� - -------------------- Date.---- FINAL INSPECTION BY:------ 1�1--�<- i�' ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American.Street 300 West Oak Street Tracy, California Stockton, California Lodi, California � Manteca, California ES-9-2M B-51 Revised W-2100