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FOR OFFICE USE: m 2� ° �. Permit No. "� ---.- APPLICATION FOR -SANITATION PERMIT 6/t_.C" (Complete in Duplicate) r r p ) Date Issued Ifl- ------------- This Permit Ex ices 1 Year From Date issued --------- ------------------------------ ---•------- A Application is hereby made to the San Joaquin Local denatncDiNoG549.a permit to construct and install the works herein described. Pp This application is made in compliance with County JOB ADDRESS AND LOCATION------------ ------------ Phone _).,. Owner's Name------------- -- Address-------------------------------- -- Phone-4-14................. •--••-•-•--q--•- I E 12_-----S c► -------- Contractor's Name- -r----- �� -1 I r �._�.1� =5Other ,,..,ti•l Trailer Court-❑ Motel ❑ ❑ Installation will'serve: Residence 5r Apartment House ❑ Commercial ❑ , oms _-�-_ Number of baths _ Lot size -----7.7 1--2�------------------------- Number of livingunits: __I---- Number of bed ro _ Water Supply: Public system V Community system ❑ Private ❑ Depth to Water+table_65ft• Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan Character of soil to a depth of 3 feet: Sand ❑ ❑ FHA/VA: Yes ❑ No Previous Application Made: 11f yes,date---_---- ----.) No V1 New Construction: Yes ❑ No s TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted J public sewer is available within 200 feet.) Material k Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------- - acit Liquidde th----------------------- P y----------------------- No. ----------------- - ❑ , -� No. of compartments_---- Sixe q p ; r a ° i . Disposal Fiel Distancefromnearest well`h.8'±^�--,Distance from foundation-------I-�"-`-----=Distance to nearest lot ine___"__ _...___. .: --"_---Len n of each lin Number :- ---s Width of trench _)_----------,.ZO-" 3 Number of lines---•----------I glength - Total - Q Type of filter) material__ t_4—— --iDepth of filter material-.__ -. �, I ,, r Seepage Pit- Distance to nearest welL.'"!!�-e' '� --Distance from foundation-_____me AJD r.l- D---43n� !- toDne�pptk- lot -- _--.__-_-- l�,U[CSize: Diameter-5------- -- 1 Number of pits-----------I- Lining material___•'-------- P i -- -------Lining material'------------------------------------ Cess Cesspool: Distance Diameter`nearest we ---:: Depth from foundation-- -- Liquid ----------------------------gals. -_-_-_ Distance from nearest building---------------------------------- Privy: - - -- Distance from inearest well y ----- i Privy: ,--. _ - -- ❑ Distance to nearest lot line-------------------- R ---------- Remodelingand/or repairing (descr4be):_-._-----A-A.Q-------A�-------- xIS _�L_h'- --- ------ ------------ t -----•- ----------------- ----------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ----------------(Owner and/or Contractor) ------------------------------------------ Si ned e _ BY -- ---------------------------------------------- --------- (Plot plan, showing size of lot, location of, s tem in relation #o wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY DATE_`----!'�ZZ"--4-�-�------------------------- APPLICATION ACCEPTED BY___. :.---� a------------ --------- I REVIEWED BY--- ------- ----- ------- ---�-- .................� ------ ------- ------ "------- ------ ------- -------- ------- ---- DATE--------- ----------------- ----------------------------- ' ------ DATE------------------------- ---------------- -- ----------- - BUILDING PERMIT ISSUED------------'----- ==------------ ----------- - ---------------- ----------- A-------- ------------ ----y Alterations and/or recommends Z -.__ _ ----------$ ' Lyp-'--- - '.---------I---------=-Ln s tc1� - = -R� --------------------------------- ----------------- ------------------ ------------------- - ------- ------------------ _ _ ,. ;Dated t ----------------------------- FINAL INSPECTION'BY:�--�..�.-- --- �- - SAN JOAQUIN LOCAL HEALTH"DISTRICT 1601 E.Hazelton Ave. 360 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.