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APPLICATION FOR SANITATION PERMIT Permit No. °----- �"L (C(Complete in Duplicate) G/I S omp p ) 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. !� f �_1/' ll��tJJ --------------- JOB ADDRESS AND LOCATION - Owner s Name------- - �..t�as. ----- ---------- -------------- ----- ------------------------------------- -------- Phone------------------------------------ Address---------- _ -- - - -----------------------------------------------•-------------------------------------•----------------------••-------•--- /(� Phone------------------•-------------•-- Contractor's Name-----------t„t-`r`-„y ------ -------------------------------------------- Motel Other Commercial Trailer Court ❑ ❑, ❑ Installation will serve: Residence Apartment House ❑ ❑ l r Number of living units: __�____ tuber of bedrooms __!___. Number of baths _______ Lot size ----------------------- — Water Supply: Public system [ICommuriity system El- Private Depth to Water Table ft. " Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ �Adobe7K,Hardpan ❑ �o Previous Application Made: Yes ❑ No"0' New Construction: Yes ❑ No JW FHA/VA: Yes ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic.tank or cesspool permitted if public sewer is available within 20D feet.) Septic�T �nk: Distance from nearest well� .......Distance from fo ndation___ Mat ria No. of compartments------�------------Size--- -- "�- -._Liquid depth-----4-------------Capacity-- - ----•- bisposal Field: Distance from nearest well__��_3 Distance from founded n_._��--__-___-Distancefto nee est lot Iir� •v1 Number of lines_.____" ___. ------=Length of each line------ Width.o � " th of filter material--- ��1---------Total length_---- -- ---'---------- Type of filter materia ____Distance from foundation____________________Distance to nearest lot line--_-.---_-.____._ Seepage Pit: Distance to nearest well.__. ----------- ❑ Number of pits Lining material-----`-- -------Size: Diameter-----------------------Depth_----- ---------' ---------------------------•----- Cesspool: Distance from nearest well------------- '-Distance from foundation--------------------Linin materia!_ gals- El als. ❑ Size: Diameter------ ---------- --------------Depth----------------------------------------------------Liquid Capacity----------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ID Distance ----------------------------- ------ Distance to nearest lot line__----------------------------------------------------------------------- ------ ---------- ---------- Remode4ing and/or repairing (describe):---�~__- ---_ '�'-+► --------- I ------------•-----------------------------------------------'------------------------------------------------ -------------•---------------------------------------•-E--'�tn- ]VS -- F-------------------------------------------------------------------------------------------------- I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc s, tate laws, and rules nd re ro s of the San Joaquin Local Health District. (Signed)----. . w-'� ;� __-- -------- -- - - �,---------- ------ --- ------------------------------------ ------------------------(Owner and/or Contractor) ------- - - -- Title (Plot pt , showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE----- ..- APPLICATION ACCEPTED BY-------------------- ----.-- --------------------------------------- ------------------ ----------------- DATE---------------------- --- - REVIEWED BY - ------- - - ------------------ ---- ------------------ BUILDING PERMIT ISSUED--------------------------------- DATE----------- --- - -Alterations and/or recommendations:- _.____ -- __._--_ - -----------------------••----------------------------------•--------------•--- •------- ---------------------•-- --------------------------•-------•--- ----------- - ------------- ------ ----------------------------- Date._..._L./fa.t_C� `"��---•�- -- -------------------------------------- FINAL INSPECTION BY: SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street l 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stock+on, California Lodi, California Manteca, California y ES-9-2M Revi'saa 1.57 F.P,M