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APPLICATION POR SANITATION PERMIT Permit No. ..f---- yM_ / (Complete in Duplicate) Date Issued This Permit Ex fres 1 Year from Date Issued �� bLrp—s r . �ppliD .s.._ ca }ion is hereby made to the San Joaquin Local HealtnceQiNoG 549.a permit to construct and install the work he+ern described. This a"pplicat0 '.is mad in-compliance with County Ordina —.� ------------ --------- JOB ADDRESS AN LOCATION Phone ------ ----------------- 1. ----------- '1 Owners Name---- - fS �... 4-----•--•------•--------•-• -------------------------------- ---- Address ----- --• - Phone-------------------- - - J--------- Other 1 Contractor's Name---��g Trailer Cour# ❑ Motel ❑ Installation will serve: Reside ce ❑ _Apartment House' Gomrnercial ❑ Number of living ursi}3 -- Number of bedrooms ....... Number of baths --i--"- Lot size + ---------- i Private Depth to Water Table 1,.'Q- ft. 4 [3 Water Supply: public system ❑ Community system ❑ Loam Clay ❑ Adobe ❑ Hardpan ❑ Gravel Sandy Loam N Clay ❑ No ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ , � No 'El', FHA/VA; Yes ❑ previous Application Made: Yes ❑ No 51 New construction: Yes ti , TYPE OF INSTALLATION AND SPECIFICATIONS: (No-septic tank or cesspool permitted if public sewer.is available within-200 "".Mafierial_--�� ----------------- Septic --- � ---- - Liquid depth-----' ---- Capa y-•- ------ -- ' Septic Tank: Dis}ante from nearest welLs�O�-----___Distance from ize�tQ-t �=oun a ion---- No, of compartments--- Distance to nearest Distance from foundation-- --------- --- y Disposal Fie4d: Distance from nearest well--- -a----- - Width of trench-_A_Y_ "-------------------•- Len Length of each line...... 4-- Number of lines------------ '------------- 9 '• -Total length-----`{��---------------- Type of filter materia -Depth of filter material--- Distance � -_____-"_--_--_-pisfiance from foundation"-------------------Distance to nearest lot line_-- Pit: Distance to nearest well----- Size: Diameter---_------------------.Dept h-_----------------- ❑ Number of pits----------------------Lining material--------------------- Dis#ante from nearest well----------------Distance from foundation--------------------_.Liquid Capacity---------------------------9als. i I Cesspool: �b3 ❑ Size: Diameter-------------------------------------- p Distance from nearest building Privy: Distance from nearest well_- -•------- ------------------- --------- iI _- ---- -- ----- -------- ❑ Distance to nearest lot line_-"-_._"--_--"_-_ Remodeling and/or repairing (describe)=------------•----------- - -----------------------"----- --------------------- I� ---•--------------------------------------------------•--•------------------------------------------------•-- ----- ------------------------------------------------- ------------------•------------- 1 -------------------- ------------------------------------------------------ ------------------------------------- prepared this application and that the work will be clone in accordance with San Joaquin County l hereby certify that I have ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ------------------------------------ - --- ------------------------------- (Owner and/or Contractor] -------- - -- -- -- ------------ -----------= --�--------_--�='----------(Tit --= By-------------------------------- -------------- e} r (plot plan, showing size of lot, location of system in relation to welts, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- --------------------------------- DATE---� "c�`•••�1 ------------------------------- - ----------------------------------- ------------D--A---T--E---------------------------------- ATE--- ----------- - -----•--------------------- -------------------------- -- REVIEWED BY"-------�----- - ---- --------------------- ---- ------------------ --- BUILDING PERMIT ISSUED------------------------------------------- ------------- --- -------------------------------------- Alterations ------------ ---- Alterations and/or recommendations:----------------- ------- ----------------------------------- ---- - ----------------------- /° Date- FINAL -- ---- --- FINAL INSPECTION BY - SAN JOAQUIN LOCAL HEALTH DISTRICT f32 Sycamore Street 814 North "C" Street 300 Was{ Oak Street Tracy, California t30 South American Street Lodi, California Manteca, California Stockton, California Fs-9-2M Revised 0-'59 F.F.Ca.