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FOR OFFIC USE: APPLICATION FOR SANITATION PERMIT Permit No. ....-•-_.... L. .. (Complete in Duplicate) Date Issued _... This permit Expires 1 Year From Date Issued Y Application is hereb made to"the Stiri"liiaqulnToca ea District for of to construct and instal!the work herein descry e . l Thisapplication is made in compliance with CountyIOr ." - - No. 549• ,R 4 .. -If---------- i JOB ADDRESS AND CATION hone.._..•-----•----•------------- --- -d-. - --- -- ---------------------------------------•--;- P Owner's Name-------- _ -•- . - _ ............................----------.---..._......._. -7/ Address <. - hone,. I,4 � �x -----------------------------------------•------ ------- P Contractor's Name--------.' _ 4-1� " f` Motel Other ❑ �� Trailer Court ❑ ❑ Installation will serve: Residence L " ---Apartment House ❑ Commercial ❑ /. � �J Number-of-baths-_1_---=•-Lot size ______________ Number of living units: _ __ Number of bedrooms _ca- - � t, _. l Pr;vats - Depth to Water Table '�-Sft. Water Supply: Public system [Community system ❑ CIAdobe�rdpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam ❑ B L��Y❑FIiANp` Yes ❑ No❑ Previous-Application Made: (If yes,date-------- - ------- No F1 New Construction: Yes ❑, No TYPE OF INSTALLATION AND SPECIFICATIONS: t P e,se er is available within 200 feet.) ` No septic tank or cesspool ne permitted bile, from foundation."" �-------Material . Se tic T nk: Distance from ' < __--"capacity p P tY ' Size. x_5_ -9 Liquid depth �.1. No. of compartments._____s,�------/-,--/=-----� - �l/' _Distance from foundation_..,/4-,/--•-=•Distance to nearest lot line..._-----•- Disposal field: Distance from nearest welh�r--- Length of each 1'sne___.___. ----•- Width of trench..__.. .. ------------- ❑ Number of lines---------f----- ,.. �'• Total ion th_. D--.- 10----- �. 1 Type of filter matenal...$_I_- " !Depth of filter material_.___/s4_____- j g De th------�¢� • •------- -` � ,j 4 Seepage t: Distance to nearest wdli_/�(ll -Distance-f m foundation_._`.Ip------ Ince to nearest lot Ins._.._ _..-..." Linin material., f1 l - Size: Diameter___._f g Number of pits -----•---- \ Distance from nearest well_________________Distance from foundation-__._._.---.'-.-- Lining material..___.___.._.----.--• "''""als. Cesspool: , - Liquid t ❑ Size. Diame'ter-•---------------------- ------Depth----------------------------- LIq Capacity- Distance from nearest building--------•-----------•----- k Privy: Distance from nearest well---------------------------------- ----- C ❑ Distance to nearest lot line---------------------------- ------------- --.._.-----,-----•--••--------•------•-------•--- -- ' I ! -----••----- -- ` Remodeling and/or repairing descriae ---- ----- --- j� 7 •-- 1 _ / ----------------- - ---------•---------------------- ------------ ------ i ----------- ; ! I L j ,-� } ------•-------- ---•---------•------ -------•------- k N -------------------------- .. 1J,. . I hereby certify et I have prepared this nPpoli the San Joagui hLdel Heaork lltheDis}r1�}n �[ccordance with San Joaquin County O ordinances, nd State N"and rules, ;�- / ^ `I .. ( nor• 'nd/or Contractor) (Signed)_ •• -----------• - �` --------•--- ------ -------..... ........-..-.----...... -- ' _�G� . $y:------------------------------------ ;----------•---- � =4- -- (Plot plan, showing size of lot, location of system In relation to'wells, bu�din s, a c., can be placed on reverse side). t FOR DEPARTMENT U ONLY = ` . ' f DATE E _. C_. . ------------------ ---------------- APPLICATION ACCEPTED 13Y. , � _I_ / , /' ----------------------------------------- t * -------------------- ----- -- 1 _ -- : '- -------------- r REVIEWED BY-----------•----------------- - Df4TE.. BUILDING PERMIT ISSUED------- ---------- ---- `------ I f t ` Alterations and/or recommendations' `- 1. ,� ..__ �' �, . � d 4 . -1:-.110-0------------.---•----"---- 3 _ c G.�l ----------------------- ------------------- -- ---------- -F. -._ Date_ . .:--= 0--a_ FINAL INSPECTION BY...... --- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stnot 1 134 Sycamore Stroll 305 West 9th Street Lodi,ColfforL+la „d. �•� � nlrca,�Caltfornla�"'.;+ .".: Tracy,California Stockton,California 4 ES 9 REVISED B-59 ZM 5-61 ATLAS Y p _.