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Per No.-------y--�---"--•�- - r { X111 APPLICATION FOR SANITATION PERMIT Issued /- r F --a (complete in Duplicate} Data cal'Health District for a permit to construct and install the work herein described. hSan Joaquin Lo . Application is hereby made to ante w th Count Ordinance No. 549. application is made in.: P_.; _..�.4 "`"`�------------------------------------------------- ----------- - ------------------------ -- This app. .r� • - -� Phone----•------------- - - - - - - ---------- JOB ADDRESS AN LOCATION_.l�ic--------------- e-- --------------- " ---------------- one Ph -- Address--�-- -- -- -- --- --." h -------------------------- - ------- - -- - Motel ❑. Other [►J Contractors Name -------------- "� Commercial ❑ Traile ourt ❑ , Apartment House ❑� - i. installation will serve: Residence ❑ P - "". Lot size ---- - ��-------------•--- • of bedrooms Number of baths - -- Number of living units:`" -----I Number private ❑ Depth to Water Table I } Public system [i�Commun'ity `system ❑ ❑ clay Adobe � Hardpan ❑ Water Supply' � Gravel Sandy Loam ❑ Clay Loam Y ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ o ❑ FHA/VA: Yes F] N° ❑ `Construction: Yes [�� Previous Application Made: Yes ❑ No { TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if uJbli sewer is available within 200 feet.) Distance from foundation", ---------- M jer al r-_ ' - ----- Distance Capacity-/ ' Septic Tank: Distance from 'nearest wei "-_"- ❑/ No. of compartments c Size. Liquid depth--.�� i t ! Distance to nearest lot line ----------5� _ Distance from foundation-- ------ Disposal ield: Distance from nearest we - -- ?� Width of trench-_�,�""---------------------- Number of iines---------------------------- --- Length of each line---- �� Type of filter material__" � -- Depth of filter materia4_---_/ --------- Total--- t D _ x _.,. r ,I! 57 Distance to nearest lot line__ f___-____----• Seepage it: Distance to nearest well ---Distance om foundation-"" De th r`s c,247! -------------- nearest P' ------Lining mate ria Diameter .. p Number of its__"-_/__-____- - ing Cesspool:. Distance. fi om nearest well ----------------- from foundation._-__------ - " Liquid Capacity gals. ❑ . Size: Diameter----------- -------- ---------- ------Depth--------------------------------------------- q p Y Distance fran nearest well ---------------------------- Dis#ante from nearest buiHing ------------ --------- 4 Privy: ., - ❑ 4 Distance to nearest loft line----------------------------------------------------------------- 1. Remodeling and/or repairing (describe)---------------•---------------"---- --------------------------------------------------------------------------------------------------- 1 ----------------------•------------------------------------------ I ; 1 ------------•--------------------------"---------------------------"----------------------------------------------------------- - I hereby certify th. at I have prepared this application and that -the work will be done in accordance with San}Joaquin County ordinances, to laws, and rules and regulations of the San Joaquin Local Health District, (Signed -.- __{Owner and/or Contractor) ---------------- I..../�.L ------ ------------------------------------{Title)------- - ----------------------------------------------------- By: --------•-------------------------- - (Plot plan, showing size of lot, Iota+ion of system in r +ion +o wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---7 �`d--r----------------------------------------------------------------------- DATE "s G' REVIEWEDBY ------- ------------------------- ---------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------- ----------------------- DATE------------------------------------------------------------- Alter ions and/or recomm ndations--------- ------------"------------------------------------------------------------------ ��..- --------------------- ------------ ; - - �y.�� ' Date-----------------------------------------------------.(f -.`----------- FINAL INSPECTIo SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M : Revises 1-57 F-P.CO.