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Permit No. 7 APPLICATION FOR SANITATION PERMIT n (Complete in Duplicate) Date Issued 1nNY& Application is hereby made to the San`Joaquin Local0 denatn eDtNoG 549r a permit to construct and install the work herein described. This application is made in compliance wird .y JOB ADDRESS AND LOCATION_.____l_----J k ----------- - - ------------ - ------ - Phone_ ------- ---��----------- Qr zt , . Owners Name------------------- - Phone_ t Address-...--------------------------- ---- --------- l 1 Contras#or's Name - 1 - >---tip - - Motel ❑ Other i Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ \_ Number of baths _/----- Lot size ---�-A- 7Q -------- Number of living units, __l__._ Number of be _�_ { Private ❑ Depth to Water Table -------- ft. Water Supply: Public system `Er Community system ❑ Clay Loam Clay ❑ Adobe [ardpan ❑ I Character of soil to a depth of 3 feet:i Sand ❑ Gravel ❑ Sandy iLoam ❑ y ❑ ! Previous Application Made: Yes�No L7 New Construction: Yes �No ❑ FHA/VA: Yes ❑ No Pr PP TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or'cesspool permitted if public sewer is available within 240 fee ) t r. � -- -- -� f q�T -x Y Liquid depth----- 1/----------------Capacity----_19� Septic T k: Distance from nearest well!Wrt'`?-==`-Dista.nce-from foundation__.____.___."._ __.Matena______________ _____ No. of comparfiments--__._x-________".__._.Size_.___.. w. V to Disposal Field: Distance from nearest well"_ ---.Distance from foundation_"`_tr?______-___ --Distance to nearest o tne___ ............ Number of lines------__------------ --- 9 f� e Len th of each',line_____Q- -Width of trench___"_ +�-----...........t - - De th of filter material___f --------------Total length___----------. Type of filter materiaL__Y_W-`-------- p Seepage Pit: Distance to nearest well -} LiriingtmDateral {rom foundsZenDiame#er Distance to�ep est 4ot line--_-_--"=;_--_. tPOO th Number of pits ` --------------- El U Distance from nearest well-----------------Distance from _foundation___ -___..._ Lining materia ___ ____ _________ Size: Diameter __ _ pepth_ =t. '"'�.� ��-�. .= Liquid Capacity------------------- --- 9als. Cesspool: ` Distance from nearest building----------------------------------------- nearest well-------------------------- Privy: Distance from - ----------------- - ------ ❑ Distance to nearest lot line._____------------------ ------"------ Remadeiin and/or repairing describe :____ g p ' g ( ) WF__LL'A-V—,T -------C'A5-F------------------------------,---------------- ,� ---------------------------------------------------------------------------- - ------------ j _ht AI- a- ------------- - - - --------------------------------- __. = _ - _ I hereby certify that I have prepared this applik will be done in accordance with San Joaquin County cation and that the wor 3 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. F _ ----___-_--(Owner and/or Contractor) ---------------------------- (Signed) . ---------------- ------------ -----------;,f ...................{Title) $Y {Plot plan, showing size of lot, los ion:of system in relation to wells, buildings, etc., can be placed on reverse side). } FOR DEPARTMENT USE ONLY --.- - —.. F.._ L—.._. _ - --. -_ APPL{CATION ACCEPTED BY____ - DATE------ � '� REVIEWED BY-------------------------------------------- ------ ------------- ---------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------- -------------- DATE ' ------------------------------------------------------ ---- ---------- Altera#i ns an /or recommends tons:__"_____ ___ _____"" --- -- -------- ---- - -- - - - ---------------------- ------- ------- - -- QAa__�---- � -------------------------- -------------- ------ Date------ FINAL INSPECT BY __ _ __ _ __._ .- - , SAN JOAQUIN LOCAL HEALTH DISTRICT 300 west Oak Street 132 Sycamore S#reet. 814 North "C" Street 130 South American Street r ;`" Trac California Stockton, California Lodi, California Manteca, 'Califarrtie Y. t4 f ^ ES-4-2M , Revisea 1-57 FY,CO. } F