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FOR OFFICE USE: 1 O \ Permit No. _.�_��.. ........ ------------------------------------- -------------------- '-APPLICATION FO SANITATION PLMMIT ----------------- - ------------------------ bf r (Complete in Duplicate) Date Issued ------------•.-._------ - - =----- ------ - --- - This Permit Ex ires l Year From Date issued Application isyhereby made to the San Joaquin Local Health District for a permit to construct and install the work rein descrbe . This application is made in compliance with'C5unty Ordinance No. 549. �- .1 �� . --------- JOB ADDRESS AND LOCATION--C__��L- --- Phone ------------- ---------------- Owner -----•----- - ----- i Owner s Name-_. j �° �" T - ,� a-°-• .. -- j --:`--.�. '�=----------- • _ b o 5 Address -- *. one. Motel ❑ Contractor's Name-----� �; s - Other 1� 4" z Apartment House ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence C) p 1 Number of living units: -- ----- Nu tuber�of bedroo ti I k .------- Number of baths ----..__ Lot size -------------• Water Supply: Public system ❑ Community system'❑ Private ❑4 Depth to Water Table it. Hardpan ❑ -Gravel dSand Loam +Clay Loam ❑ Clay ❑ Adobe❑ i Character of sail to a depth of 3 feet: Sand []. , ❑ .. y FHA/VA- Yes ❑ No� i Previous Application Made: (If yes,dateE;.-- E----),1,No14 New Construction: Yes No TYPE OF INSTALLATION AND SPECIFlCATlONS: �� . r cesspool ermitted.if public sewer is ay..ailable within 204 feet.) „-- (No septic tank io p P r - --- • Septic Tank: Distance from nearest`;wel4___,�j_ ---Distance from found, tion.__�_ .---_----Material- Distance Capacity_.iZ g-I No. of compartments"- --- Size__.--Kl� .r,3 Liquid depth----- --------- j �r :Distance from'foundation'"'�=r-- Distance to nearest lot li/n;____.----------• Disposal Field: Distance from nearest well_.,�j;_� f Wid#h of trench.__..' ------------------•- Len til of each.line ` - 1 � Number of lines----- g :a pe th of filter mat ��_ _ _ Total length___-1-64--•-.--•---- Type of filter material--- C " pr «. 1.. Seepage Pit: Distance to nearest well_____________________Distance from foundSize: Diameter--------------- ----------------- •D'sstance to nearest lot line.___-,.---_--- ❑ Number of pits----------------------Lining material_---------- ------- Cesspool: Distance from nearest well-----------------Distance from foundation._.----- --- Lining id Capacity-------------------------- El _ _______________________gals. ----De th------------ =---------------- ------------= 9 ❑ Size: Diameter- - p . -Distance from nearest building -------------------------- Privy: Distance from nearest wJ---------------------------- .,� ❑ Distance to nearest lot line-----------------------------------�----------�•'------ "--•---- ---------------------•-----------•-------- " q -------------- Remodeling and/or repainng (d©scribe): ------------------ --------I--------------------- -•---•------- '------------------------------=--------- .......... c �� �. 1-. ti. --------------- ------------------- -----------------------•----------:---- I hereby certify that ! ha epared this application and that the work�`�will be done in accordance with San Joaquin County I ordinances, S laws, and fes nd re ulatio4oflSan Joaquin Local Health District: n \\ �' ! ',----------(Owner.and/or Contractor) I Sin -- - --( g l , l ----BY:-----------------•----------------•-------•----------•------- n g _,_ ,ced' . -e,_ver.e si buildin s, etc.,'can be placed on reverse side}. (Plot plan, showing size of lot, location of system in relation to wells, F R DEPARTMENT'USE ONLY �y / ----------------------------------------------- DATE 3! r-. 77-- ---- ------------ -- APPLICATION ACCEPTED BY- f DATE------------------------------------------------------------ ........ ------------------------------ REVIEWEDBY ------------------- ---------- --------------------------------- BUILDING PERMIT ISSUED------- ----------------------------------------------- ------------ Alterations and/or recommendations:.__._...__...................____-_._.____.-_ ------•------- -------------------------------------------------•---------------------- --- ---------------------•--- ------------------------------------ --------------------------------------- 411- --- Date------ --------- FINAL ------- ---------------------- FINAL INSPECTION BY:_._ _. _.a --. - ---•--- '--- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 sycamore Street 205 West 9th Street 130 South American Street TracCalifornia { Stockton,California Lodi,California Manteca,California Y, EB•9 REv Igr"8.69 F.V.Co•2M 6-66 - - -