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I-,L OF ICE USE: `� ¢ _ Permit Na. _�-�p---'�-•--•-- ------ -------- APPLICATION FOR SANITATION PERMIT Date Issued .— j _ _ _ _ (Complete,in Duplicated This Permit Ex ires 1 Year From Date Issued ------- ----- -':y _ . Application is hereby made to the San Joaquin Local Henan eDiNoc for.a permit to construct and install the work herein descry e . Thispapplicatiori is made in compliance with County Ord r x'33 ------------------------------------ JOB ADDRESS A D CAT N---- ------------ ---=--"------ Phone-----•---------.--=---------------- =- - _ �� -------- Owner s Name__ � � -----• 3 --A'r`t ------�-- ------------ L_ one-----•-----------------•----------- - � Contractor's Nam __ --1y__7------ --••------------------------------------------------------- ----•----•-------------------- .- - - -------- Motel Other ❑ 1. ---------- Commercial ❑ Trailer Court ❑ ❑ s Installation will serve: Residence [T Apartment House ❑ -7,.� • -------------- Number Number of livirig units: __�____ Number of bedrooms _ --Number of baths -1----- Lot size �' Private epth to Water Table _�d ft. _ .Water Supply: Public system ❑ Commuriity system ❑ �� Clay Loam ❑ lay ❑ Adobe �a dr Pan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y New Construction: Yes No ❑ FHA/VA: Yes ❑ No ®— Previous Application Made: (If yes,date-------------- 1 No` ., I TYPE OF WSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public is available within 200 feet.). Distance from nearest well-Ste-.."----Distance from�ou�nd---Liqu d�depth--M e-i------------Capacityp - Septic T ------- ..--Size---- - s No. of compartments_____ "-- t t dU._ 0 1-"-_•---_.-_"--.Distance to nearest lot line ____________Irr y i Disposal ..ield: Distance from nearest well____ _ ______Distance from foun a ol --30---"--._.Width'of trench_.__�1,-------- Number of lines..-,;-2 __ Length of each line__ s ` ` _Depth of filter materialTotal length----9b l/ J { Type of filter materia( o-G�S"""--__ 1 -------- r . 3 _ .�...T.- ' �' Seepage Pit: Distance to nearest well_/QQ__------ --Distanc [0 G`foundation-zienpl¢eter -a to sce toDneepa+�st line-- ----- fir'' • Number of pits-_-.-I-------------- Lining materia __-- ----.--- � ; -� �� s Cesspool: Distance from nearest well_____________"-•-Distance from f un---- ._.."___------------Limtu d Capacity------------------------------gals: C --}De th ............ -- q t ❑ Size: Diameter-------------------- - Pr _-- v� Distance from nearest bui ing._-----------------------------"-- ------ }1 Privy: Distance from nearest well------ " -------------------- ----------------"-------------- ---------------------- ------•--- s Distance to nearest lot line---------------------------------- I ------------------------------ ---------------------------------------------------- 1 ---------"-------- Remodeling and/or repairing (describe)::_________�-_____-" .- _____________ e ------------------- ----------------•---------------------- ------------------------------ -------- -------- ---------------------------- --"--------------------------------------------------------------------- ---------------------------- ------------------—- ------------------------- --------------- - done I hereby certify that I have pandareduthis lationapplication olf the San Joaquin hl-calkHeallt4�eDistr ctn accordance with San Joaquin County ordinances, State laws, and rules g + -------------------------------------------------(Owner and/or Contractor) {Si ned g -------------------- ---------------------------- ---- ------ -- 9 (Title) i BY= (plot plan, showing size of lot, location o system in relation,to wells, buildings. etc., can be placed on reverse st e. FOR DEPARTMENT USE ONLY -- DATE---->�-",Z-Zi7---�y------------------------- -- APPLICATION ACCEPTED BY- ---"- --- ---- - - ----�------•--- DATE------ ----------------------------------� --------------- r ---- REVIEWED - ------------ :__-7� - -- BUILDING PERMIT ISSUED---------------------------------ti---- DATE------------------------------------------------- BUILDING „ I Alterations and/or recomme dations:_e- T� --- -- •----- --- ---------------------------------------------------------------- ----------- ---- ------- ---------- ---------�7---------- -------------------------------- -------------- --------- ------ -----"---g 1 - -/z”-- -- 7 s------- --- Date-_._.. -----�--- -Z.. .---`- --- FINAL INSPECTION - ! SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1601 E.Haielton Ave. 300 West Oak Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'S3 F.P.0