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4OR OFFIU USE: `6 -----------------------I----------------------- APPLICATION Permit No. ION FOR SANITATION PERMIT ----------- - --------- ---- ----- - - -- ---------- (Complete in Duplicate) Date Issued �r / --- -- -----------------: . . This I PeirnifExpires I Year From Date Issued ------------- ------ al Health District fora permit to c str d install the cork 17erg-irk described. PI i eb with ourify Ordinance No. 549. Phone------------------------------------ ------------ P-S--•------- ... ..... .... ---- ------------------------------ ...... Owner's Name ---- -- --------------------- ----------------------------------------- -------------------------------------- Address-------PC_ ------a_v.,q, . ......... .. ..... --- ----N'to ----- ------------------ Phone.6. Contractor's Name---- -- ---- Motel Ej Other Installation will serve: Residence Apartment House ❑ Commercial F1 Tr fler Court 0 a , t 1Y ❑ Number of living units: .../_ Number of b'edroom&A--- Number of baths -----�-Zi !✓ot size f Water Supply: Public system El Community isystem P-_11rilaten Diapt'P"to, Wat,er Table ft. Character of soil to a depth of 3 feet: Sand El Gravel E❑.] Sandy Loam [P,-T lay Loam [3 Clay E] Adobe 0Hardpan C1" k - I Previous Application Made: {If yes,date--------- - ------- No,E] New Construction: Yes No El FHA/VA: Yes k- No El TYPE OF INSTALLATION AND SPECIFICATIONS: --(No-septic4.fank=or.,cesspool-permit.ted-ifrp bli availa 6le-within,20.0,feet.) ublil Distance from nearest well_ Distant fro fouri�a ko Septic Tank- Dar ie f, i _.Material...- -- - ------------ k No. of compartments-'.�Z-1-------------- Liquid dep.fh_____4SZ. ------- Capacity-2 11 Distance to nearest lot line__-_::F7_ spop.1 Field: Distance from near le 01 Di a_jrt weLet�-Distance from foundation ig-/__* __ -------'Width Of trench-----ZT_6-- Number of lines-- --- -------- Length of e l,n ---------- ___ 4_" -------- or kC., LD' r e ---- length__----- ----------------100- ------------- Type of filter mi 4-1 f r'al--- - ----------- Depth of Iter n erial--- Total u from unclation ------------------ Distance to nearest lot line...Iq Seepage Pit- Distance to nearest well.......--------------- istance S�z, Dian --- ....Depth-----------------------------T'JR-0, Number of pits--------------------- Lining material ....... .....Size:;Diameter.------- ------- El TIC)5- 4 ----------------------------------- VOW Cesspool.. Distance from nearest well-----------------Distance Grin foundSTIon-------------- ning mate %P Size: Diameter----- - ------------- - --------------Depth--- ------ ------ ----- --------- -.-Liquid Capacity- - -------------gals. ❑ PrivDistance from nearest well_____...__-._.__-------------------------------Distance from nearest building---------------------------------------- y: El -- Distance to nearest lot line------ -----------------------------L-------------------------------------------------------------------------------------------- r 'a Remodeling and/or repairing (describe):------ ----------- ------;----- -------------------------------------------------------------------------------------------------- - - -------------- I ----------------------------------------------------- ----------------------------------1---------------- ------------------------------- - ------------------------------------------- --------------------------------------------------- ------------------------------------------------ ------------------------------------------------------ -------------------------------------------------------------- 1 --------------- --------------------------------------------------------------------------------------------- - ------------ ---------------------:------------------------ ----------------------------- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County f the S Joaquin L I Health.District. ordin6nce�s, S a+ rules and regulations o e 9 0 4r :un �L ..... . ...... -------------------- 1wffw-, lonlractorj,� -41- 7 [Signed}. . .... ........ ------ '2�. . .. .y Title)--------------------------—------------- —-------------- e of lot, location e ---------------- ------------------ gs, et can be placed on reverse side). (Plot plan. showing six of system in relation FOR DEPARTMENT USE ONLY DA -------------- ---------------------------------------- R_ APPLICATION ACCEPTED BY---- ------------- -------- ---------------------------------------- DATE------------------ REVIEWED BY-------------------------------------- ----- DATE BUILDINGPERMIT ISSUED------------- ----------------------------------------------------------------------------------- Alterations and/or recommendations:---------------------- -------- ----------------------------------------------------------------------------------- ---------------------------------------- -- ----------- -------------------------------------------------------------------------- ----------------- ---------------- - - ---------------------------------------- ------------- --------------------------------------------------------------------------------------------------------------------------------- -------------- ------------------------------ ------------------------------------ ------------------------------ ------------------------- ------------------------------------------------------------------------ ------ ----- - ------------------------------------------ - --------------- -------------------------------- ----------- ------------- ... ... ....... . - ----- -- ---------------------------- .......... - FINAL INSPEBY: ----------------- Date----------- ---------7 ----------- --------- , -------- ----- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 17