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F0t OFFICE USE: y �7 APPLICATION FOR-�,SANITATION PERMIT Permit No. _ `•- -•- ` (Complete in Duplicate) ----Date Issued .__ This Permit-Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �y --•--:e`------- - -------------------------------------------- --- ---------•--------•--•-- JOB ADDRESS AND CATION-___ -- P ----- - ----_ - -- Owner's Name -- • -- ----------- -- • r.. -=-1 -. ... Pone. - • i---------------------------------------------------------------------- - ------- _- -•----••_--•--_••--.. Address i I ---•--- Phone.-----••--• ------------------- Contractor's Name----------------- r --------------------------------------------------------------- -------- •-- Motel ' Other Installation will serve: Residence RAI` House ❑ Commercial ❑ Trailer Court ❑ ❑ , , --- -� �- Number of baths _/.-_ Lot size __ __ � ----- --- ----------- -""""- Number of living units: __/-- Number of bedrooms _ _ Water Supply: ;Public system .❑ Community system [IPrivate ❑ Depth to Water TableIF _ ✓ tt• Character of soil.to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loari'❑ Clay Loam ❑ Clay ❑ Adobe ga-'Vardpan ❑k .01 -„w,No-❑• FFHA/VA: Yes No [I„ .. Previous Application Made: (If yds,date__-____-- �:)_ No,Ly'�,,.,N0w;Constcuction,,Y.es• TYPE OF INSTALLATION AND �`SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearest well----_----___----Distance from foundation__/ ---------Material--! Li uid de th--- �! _ Capacity- ----- No. of compartments----t�--------------Size., --�-�,e q P. ��-- =---- { �a�-- Distance to nearest lot �e_ Disposal Field: Distance from Weare well----'- '- -.-Qistance from fqundption_�� - r, Length of ea h kine------7' 'p-`L"Width of trench-r��,_P---- _ � Number of lines___-- .-- 9 Total length- -. -�` -• ID Type of filter material- -./ �/1> Depth of filter matenal�_ ---sem_ _ , Q_______Dist�n�ce�to nearest lot hne- _____-.- Seepage it: Distance to nearest well__-"-" -__-----'Distance-f-- foundation___ Deptl>�* �- - .------ material - - Number of pits.--�__---------Lining material=_- {�- .�-Size: Diameter- -- "- Cesspool: Distance from nearest well-----------------Distance from foundation___-- material-..____--_-----___--_'----:..--.Q _-�De th- .R—T _= ------L.iquid-Capacity----------------------------gals. ❑ Size: Diameter- ----- -----=---- - o ----------- r - = Distance-fromrnearest well------------- -----------------------------------Distance from nearest building----_------.----___---- ---------------s Privy: r f- Distance to: nearest lot line----- - -- -- - - ------ ------------ ----------------------------------- - - -------- - a ------------ 3--------•-----------•------- Remodeling and/or repairing (describe):--- ;4f04/,_<--- --------------------------------- ---------------------------------- ------------- . ------------' -------------------------------------k--""'"----------`------"'-----'"-----•------------"--'"--"--------""'---'-----"-""---'--'--"""-----"-`"-------"-" :'-.- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an regulations of the_Sa'n.Joaquin-.Local-Health-District.,. - ------- ---------- r Contractor) (Signed) -- - - ----- -- - - � ------- 1 ------------- ------{Title)- ----------- --------- By:------------------------------------ - -- (Plot plan, showing size of lot, location of system i a#ion to.wells,,buildings, etc., can be paced on reverse side). OR`bEPARTMENT USE ONLY I APPLICATION ACCEPTED BY-__-. — ---------------------•-------•----------- DATE f ` --•-- DATE------------------------------------------------------------ ISSUED: BY -------- ” ----t.DATE..,-------------- BUILDING PERMIT ISSUED: = - ,=;; --------- ---------- ----------------------------- ------ �..-----c- -- -- - '- --- - --- .___---e-- �-- ___---- •��Iterations and/or recommendations-------- -------- ---�'" : ------------------------- =->.- - ---------------------- �. ------ ----------- --------------------- - - ---------- ------------------------------------- �' -- ----------------- -- ------ --- ------ _ -------- --- Date-.-----f----------- -- •-�- ------------ FINAL INSPECTION BY:--- -- --------rSAN JOAQUIN LOCAL HEALTH'DISTRICT.. i 1601 i.Haselton Ave. West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-•63 F.P.Cq.