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pi,SQ O ICE USE d �- Permit Il,o. - �----------.- APPLICATION FOR SANITATION PERMIT r r7 + P (Complete in Duplicate) Date Issued ��• ate IN _: ____ This Permit Ex fres DiYeC for Oa permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health y Ordi e No. 549. -This application is made in compliance with Countn ' 5::;A ; --- Phone - JOB ADDRESS AND LOCATION --- M.3.�� J� ---- - ----- --------- --------------- Owner's Name---- - ' Address_ ------- Phone_ 644�.3Q--�/ Other---------------- Contractor's Nam ._- - --- ---�-- �- - " Motel ❑ ❑ " Trailer Court ❑ Installation will serve: Residence Apartment House ❑ Com ercial ❑ A ��, Number of baths -1----- Lot size -_-_. -_ - - Number of living units: .___._ Number of bedrooms _-�-- }h }o Water Table �ft. Water Supply: Public system ❑ Community system ❑ Private �p Cla Adobe Hardpan ❑ r Sand Loam ❑ Clay Loam ❑ Y ❑ it Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Y No � FHA/VA: Yes ❑ No❑ Previous Application Made: (If yes,dote .11 -.-- . ---.7 No ❑ New Construction: Yes ❑ [� TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer ance ilable within ion feet.] Se tic- Ta IF Distance from nearest well-----------------Dist from foundati�quid depth -Material..-------Capacity------._---------- �i� No. of compartments...................... .. rj ----Distance to nearest/l�ot line--1-A Dispovl meld: Distance from nearest weii.f_ Distance from founOFA .0 dation..-. � Width of trench.._.k_4Z -�------------- '�i n 9 Number of lines---- -- - ------------ Length of each line-44R �/ Total' length-----I----- Q Type of filter material , Depth of filter material._ ---- I1, -- ,� �l --F_.Distance to nearest lot lin ` Jel / -De th_ 7e---------- ---- K - Seepage Pit: Distance to Weare t well- fromyfoundation.. ..._ Number of pits___ ................. ________ ___ _Luing material Rt✓t ---- --.Size: Diameter3 -...-- M Distance fro foundation...-______-.---- Lining material' ------ Cesspool: Distance from nearest well'--._-.--- Li uid Ca acct 9 } Size: Diame#er Depth : -- -------------- q p II�Y a . ❑ '.-Distance from nearest building_. -.---------- -------------------------- ! Distance from nearestrweil._____._..__.___.__ "_-- r Privy: ----- ------ r I -- Privy. nearest:lot line-:----------------------- ----------------- -------------------------- 6 _ _- ..� ` : ------------- '( Remodeling and/or repairing [descnbe):----------- -- - `J �-�' ------ I =- - have prepare this application and that the work will be done in accordance with------ ----------------�=- h San Joaquin County I hereby certify that I h p' p ordinances, State la les and re ati ns of the' oaquin Lo east rict. r r Contractor] Si Wed - [ g F _°--- --- • ---------•----------------------------------------------------- -- --- - -----' [Titley------- ------- :;M ---- Y [Plot plan, showing size of lot, location of`system'in"relation to Is, buildings, et an be laced on reverse s9 e. i FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY--- fI ` DATE------------ f_- --------------------- REVIEWED BY --------------------------- DATE BUILDING PERMIT ISSUED------------------ ----------------------- ------------------•_------------- .0 DATE. �� Alterations and/or recommendations-------------------------------- - -- --------------------- ------------------------------------------ 00 �6 FINAL INSPECTION BY:..--_ ...... Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r