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Permit No.5•-- APPLICATION FOR SANITATION PERMIT ((� (Complete in Duplicate) p e l��ud?_-_ --- --------r loir Zi - 7 J Vica{ion is hereby made to the San Joaquin Local Health District for a permit to constuct and in al the work herein describe mance No. 549. ; hps_application is made in compliance with County O t c 4 JOB ADDRESS AND L CATION— - hone---------------- ------------- ------ - °' - ;-s Owner's Nam _ -+ " . ----------------- ----------------------------- Addres •-----•- ---- -------------------- -- • ----•------ ��, Phone Name________-___ Motel Other ❑ Installation will serve: Residence E partment House ❑ Commercial ❑ Trailer Court ❑ (] of living units: Number of bedrooms __- ____ Number of baths __�_____ Lot size _..'� P-11 '" Numberg _. } ter"Su l :" Public system ❑ '•Community-system ❑ Private Depth-to Water Table ft' Adobe Hardpan❑ Wa pp Y t Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 feet: i Sand ❑ Gravel [❑ Sandy Loam ❑, Y ! plication Made: Yes ❑ No New Construction: YesX No ❑ Previous App' FICATIONS- ` TYPE ONoNept ct}a ki ,ce AND permitted if public sewer is available within 200 feet.] r ( P P p 4-P.- D�stancetifr m f}o ndati n____. t- ,. �' = --- Septic Tank: Distance from nearest well_- - Liquid depth_ _- ____Capacity.___. •-----! ,. Size-- q �7 No.;of compartments_-- -- ,rI Dispo al Feld: Distance from nearest well-��.��--�--�--.Distance from foundation__ _- _ Distance dthcoftfrench est lad inti---- ---------- Number of lines---.----I---------- Length of each line--- ,i •4 4.De th of filter material....... Total length--------•- --'� + Type or filter material,�---- � , p —,4--..k --- YYY Seepage Pit-."-Distance to nearest well------------------------Distance from foundation—------------- Seepage to nearest o ______----------- - -Size: Diameter_----------------------Depth---------------------------:------ . ❑ Number of pits-------------------:n'Lining mater.ial__--------------------- material „f N Cess ool- - Di6fa6ce from nearest well____._---y--.-=Distance from foundation---------------1_1iq1-1nuid Y Capacity gals. ❑ Size: Diameter - ;Depth = om nearest building.__ Privy:] . Distance from nearest well------- --------: --------------- -- ----- --------Distance fr --- ------ ❑ Distance-to nearest lot line__--:_'-_-"---- --------- --- -•------------------- ------------- ---•---•---; Remodeling and/or repairing (describe: ------------ s a -------------•-- ------------- ------------------ --------------- 1 ___________________________________________________________________ __________________________ ________ i •- ..- -- _- _ _ _ _ _____________________________�__.� .__.__.-___-----__=__t'_____--_--___-_--___-______-___-___--______.___-_____-________.._-____.____-.___.____._________-___...______ s 1 hereby certify that I have prepared this ap olf ate San J that the work o kHealthe done in accordance with San Joaquin County ordinances, State laws;and rules and ula r i t sem * ---- - -' Own Contractor) .' r d/ Cont or) (O ned ' - -- �- (Sig �•----------- (Ti . -- -- ---- ----. _ - --:�------- on ---- ._ on rev t-By:__________________________ _ erse ide (Piot plan, showing size of I t, location of system in relation to wells, buildings, etc., can be p ]• r , FOR DEPARTMENT USE ONLY l i } / - -------------------- DATE-----�--------- - --•�• APPLICATION ACCEPTED BY------------- ------------- fr--�,J-- rDATE----------�--�•------ - - ---------------------------------------------- - .____________.__ REVIEWEDBY------------------------------- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------=------------------------ - -----------------•--------------------------- Alterations and/or recommendations:___-E---------- - --------- --------• -------------•------ =- i --- -----------)------------------------- ----- _.------- r `� ---- ��-N ----------- ------------------------ ------- I / ' - __--------- ----- l ----------------------- ,, -------------- FINAL--INSPECTION BY _-="-------------- .SAN JOAQUIN LOCAL HEALTH DISTRICT l32 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California yy ES-9-2M Revised W-2100