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APPLICATION FOR SANITATION PERMIT Permit No. - =---------= S in Q'u licate � `� �-- �(� � • [complete- p � � Date issued _�- ----- 1` a San Joaquin Local Health Distric' for a permit to construct and install the work herein described. Applica+ion is hereby made to the q made in compliance with County Ordinance No. 549.E This application is t - 1 r"t"e_ - ----------- JOB ADDRESS D LOGATIgN. _ - --- --- ��--..- i `.. . . R++ xit.. ---- ---- - P e� .: ----- ' r _ . Owners Name---•- -- aa..-° -------------- t " ----------- _ -r -------- ------ Address p Phone---------------------------- Vic;;, f Contractor's Name = ------ -----------------------------•- ------------------------------- ---------- Motel Other ❑ r Installation will serve: Residence House Commercial ❑ Trail Court ❑ ❑ �_f ` ❑�� t. f v �__Y_ Number of bedrooms -`?'.Number ,f bathsj__f �ot size t Number of living units: ____ Co'mmUnit is stem'❑"'•'Private I epth'to-.Water Table -------- ft. Water Supply: Publicisystem ❑ Y i Y ❑ y i Clay Adobe Hardpan ❑ l Character of soil #o a depth of 3 feet: Sand Gravel ❑ }ionndY Loam s ge No �a Loam ❑ Y ❑ Application-Made: Yes ❑ No ❑V New Construe Previous App� TYPE OF INSTALLATION AND SPECIFICATIONS: No se tic tank or-cesspool permitted if public serer «s available within 200�fee#s] P _ .:�y= .- ater al - ----- .,�.. �ank: Distance from nearest r oun 4-liquid . n-- .I Cipacit __ )) Septic I � �Li uid depth-----< Y :Size- q o near • � �No. of compartments__.;___ --- �?-- � �- F9 istance from'foundationto- istance t est lot.line _ Dispos`f,field: Distance from nearest w l_ _ 1 Width of trenc'n..__--._ -- -- Number-of lines-----=--- -- I Le-ngth of each line i -� F, ---Total lengthre ` [3epth of filter material ------ ---- ---- _ Type or filter materia'.___. �e :. Distance to nearest-wells,___:_.__..__._____Distance from foundation ------- to nearest lot line---_----------Seepage Pit: r Size: Diameter- ------- -------._-----Dept"h--------------------------------- ❑ Number of pits----------------- - -Lining material_______._- - Distance f�'om nearest well__________.__._Distance from foundation--------------------Lining material____---------`-------------------• ' Cesspool: " - De th ---------------------------------- building---". '- -----------------Liquid Capacity---------------------------gals, p - Size: Diameter - -- --- # S s ar ui i Privy: - ,, _ Distange fray, nearest wel�4 Distance from ne est b ' ng__ ❑ Distance to nearest lot line------- ----1-------------- I -- s ---•------------•---------•----------------•------.•------- .e �- - Remodelingefnc/ Paring descr-7 .---• ------ ---- t ------------------------------------------------------------- I hereby certify that I have prepared this application and-that the work will h done in acith San Joaquin County accordance w cal ordinances. State laws' and rules and regulations of theSanq e ri -(p(Owner and/or Contract nd/o or Si9ned -_- e-1-1A,/In --------- ----------------- ''P Tale BY:------------------------------------------------------------------- [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY i '. DATE----� ------ ------------------- APPLICATION ACCEPTED BY - __ 'F DATE_--- -- REVIEWEDBY-------------- ----------------- -- ----------------------------------- ---- DATE--------- _------------------------------------------- BUILDING PERMIT ISSUED------------------------------------==--------•----------------------- ----- ------•------------- - ---- Alterations and/or recommendations:.__t------------- ---- --------- ------------------- 7 ------------------------- - Date------ = FINAL INSPECTI�BY:... - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North ,C' Street 130 South American Street 300 West Oak Street Tracy. California Stockton, California f Lodi, California Manteca, California cc o—��A Revised W-2100 - .