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FOR OFFICE USE: �- APPLICATION FOR SANITATION PERMIT Permit No. �'..................... [Cornp+'efe•in-Duplicate] Date Issued _ --- ------ ------" ------ ---- -- ---- _----_ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Applic pion is is made in compliance with County Ordinance No. 549.Thi � f/(�� S , j r! Y r`d------------- -D, ____________ f` JOB ADDRESS AND .LOCATION" :7_ ,3------ Phone---- - . 1,Jd+l1_S ." _. N�Q^�^ 'j��-�1 -- - Pone 'l:7_dS'-7• Owners Name ... ^_.. _ _. -- --------- ---- .. -' Q - �a . Address _5 Contractor'sName i 15- 73. ' . i Motel ❑ Other ❑ Commerdial ❑ Trailer Court ❑t x ; ; Installation will serve: Residence X ``Apartment House ❑ S, , r� Number of living udfs: -�-. - Number of bedrooms I-21F Number of baths. ......Lot,size,____ :. ? i. Private Depth to Water Table 30- ft Y w Water Supply: Public syst ❑ Community sy tem ❑ ® ❑ Clay ❑ Adobe IN Hardpan ❑ Character of soil to depth of 3.,eet• Sand ❑' Gravel ❑ ,Sandy,Loam.[I•�Clay-Loam 1 No ❑ I ' New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ Previous Application;Made: (If yes,date_..--__--�--- - - 1 No ! a TYPE OF INSTALrLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) 11 1 + $ xi Septic Tank: Distance from nearest -- ---- Dsstance from foundation_.____._.__..--e"-.Materia4 __________ _____._.----------------- r r ,o...Y�.-... 7 I_ _-_ _Liquid de th -Capacity ❑ No. of" ompariments -= Size- = q ?p: t _ t I # I i t X.- r f Disposal Field: Distance from nearesfi well. ----Distance from foundation___, - ".------Distance to nearest lot lin _____ -- Leng h,of.eae_line__------�.0�-e��--------Width of trench-------:yY- -------------- t Number:of liries.----- -� - f \` Hype of filter matenal._.R��.--- - ,--De, th of filter material-_--.«----- ------Total length---'.-..-----Q--`'-------•----------- Seepage Pit: Distance to nearest well__.._:¢ -__- ".---Distance;from foundation____________________Distance to nearest lot-lineA _._____.___----- ► r �- i ria ' �? Size: Diameter---------------------- Depth W ❑ Number of pits. Lin{ng mat l.. t +Distance from nearest well _._ l�-------Distance from foundation................. ..Lining material__.._.....____.__-t.____.- Cesspool: Liquid Capacity------------ -------gals. r+ 'Size: Diameter_ '.----- -- ---------- ._.Depth_ - ❑ Distance from nearest building. !---------------- ---------- ----- r~ Distance from nearest well-_------------------------------------ Privy: 1 ❑ ---- ------ ----- ---_. -----.------------------- Distance to nearest lot line�_.----- , Remodeling and/or repairing y(describe:------- . . ] h +-�-- ------------------- ---- r d ! G -G. 1_ -e_ a �'1-�#h -------- #_ 1 --`-- ------1--clA--------5 5 _ ---------------------------- --------- --------------------- ` -e _ s.L ' -►a- --------•----------------------------------------------------------------- --------- =-------- -------- ---- - _ — - i ' - I hereby 1certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Jaaq in Local Health District. 'F -.. - - [O ner and/or Contractors Si ned ------------ --- [ 9 s --- t . . -. ... [Title]. -------- BY ---- ------. '-------- ---------------------- --- - [Plot plan, sh wing size of lot, location of sys+e i relation + wells, buildings, etc., can be placed on reverse side). I FOR DEPA �TMENT USE ONLY i F 1DATE-- --- /!. �- - " .. APPLICATION ACCEPTED f DATE - # ; i REVIEWED BY-----------------`----------------------------------- --------------- - ------- ------------------- -----------._._------��----- ----------------- DATE--------------------------- ----[ - - �. BUILDING P`RMIT ISSUED-------- -- --------- -------- -------- -- ---- ---- #---- ----------------- - :. :. Alterations and/or recommendations:____-...--.- ----- _ --- -- _ ---_----_._-_. _.. ------------------ --- -- ------- ---- Date , .1w -----------._ . -- -------- FINAL INSPECTION BY:_..---- --- - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 308 West Oak Street 124 Sycamore Street 20.5 West 9th Street 1601 E.Haseiton Ave. c stocktan,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press