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Permit No. APPLICATION FOR SANITATION PERMIT !' (Complete in Duplicate) Date issued ---- ----`�- ork herein described. Applica+ion is hereby made to the San Joaquin Local HdealtlhcD' 9. Noc for a permit to construct and install the w This application is made in compliance with Countrifiae :t t -- ---- JOB ADDRESS A LOCAT ON - V_1 Phone------------------------------•----- # Owner's Name.----- ----- - Address_. --------------••----------------•-----------------•------------------ -----•---------------•----9 ------------... --------- -- ------------------------------------ Contractor's Name_._=_ .____-- Motel Other ' Commercial ❑ Trail r Court ❑ ❑ Installation will serve: Residence Apartment House ❑ rr_ Lot size ___-- ------ Number ' � - ------- pp ---- Number baths �---- - - --- ----- ----------- - Number of living units: __1----- Number of bedrooms C ' Community system ❑ Private Number to Water Table ___._--- ft. Water Supply: Public.system ❑ y Cla Adobe Hardpan ❑ Character of soil to a depth of 3 fee . Sand ❑ Gravel ❑ Sandy Loam Cla Loam ❑ Y'❑ Previous A lication Made: Yes dNo ❑ New Construction: Yes No .❑ PP TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) .rt .--- . - Septic Tank: w. Distance from nearest well______.._-___.- -Distance from foundation----- ___..Material___________________________________________-.__. Liquid de h Capacity - ❑ No. of compartments----- --f---.Size-------•--------- q pj /-- _ Distance to nearest lot Dnp -—------. �+ 452t_ _ _.Distance from foundationA f�' Disposal Field: Distance from nearest w II___ _________ _ 1- -_. __ Len th of each line__________ _ Width of trench.-________-----�---------------- ❑ Number of lines------:----• -- ------ g rf pe th of filter material_____---__ -- --.-Total length_______---- Type _ _Type of filter materi _ ___ _-_- __-- p Seepage Pit: Distance to nearest well_____________ "__Distance from foundation-------------------.Distance to nearest lot ine--------.______. . — - Size- Diameter-----------------------Depth--------------------------------- ❑ Nu`mber of pits----------------------Lining material--------------------- Cesspool: Distance from nearest well----------------Distance from foundation--_________________Lining materia4________..__- ----- als. Depth---------------------------------------------------Liquid Capacify__---------------- El g ❑ Size: Diameter-------------------------------------- Distance from nearest building---------------------------------------- - Distance from nearest well------------------------------------------------- ❑ -r--^Distance to nearest-lot line--------------:------------------------------ IA F S __________ _________________ ___ _ __..______._.-________.________.. r ,�irin d nb --------- Remodel g d --------------------- / g ( - r •---- ---------- - ------ ------------------------------------- --------------------------- i I hereby certify that I have 13repar9d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Joaquin Local Health District.ot 15 + ` ------------------------(Owner and/or Contractor) s (Signed) 1 3I -------------------------••-------- - - - ---- --------- - (Title) By:-----------=---------- (Plot plan, showing size of lot, Iota+ion of system in re-l-ation- p to wells, .buildings, etc., can be lace on reverse side). FOR DEPARTMENT USE ONLY DATE-- •------------------------------- --- ------------ APPLICATION ACCEPTED BY_ -•--- --------------------------------------- DATE REVIEWED BY --- ---- - ------------------------------------ DATE.---- JE - BUILDING PERMIT ISSUED----------------- -------------------------- - Alterations and/or.recommendations______________________________________----------_---------- ------ -------------------------------- . 3 Date. t-- Z--7-7 �-------------------------------- FINAL INSPECTION ,BY-----------------------Y•-- � Vii ' = SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California Pr 4-2M Revised W-2100