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FOR OFFICE USE: / G� ---- - ''---"=-"""-"" -----" "-- APPLICATION FOR SANITATION PERM Permit Np.IT .1. -.•�•5 t . . ----------- ------- ------------- (Complete in Duplicate) Date Issued .__.. �.�•••• � ----- --- ----------------------- -s_-------------------------------------- -.______ __________" ."-_.- - This Permit Expires 1 Year From Date Issued and install the work herein described. App lication is herebymade to the San Joaquin Local Health District for a permit to construct �.. . This application is made in compliance with County Ordinance No. 549. OB ADDRESS AND LOCATION a� ne.l`1',�--- J Pho I Owners Name-------------------- - - ------------------------ ---------------•----_-..----------------•------------•...------------------------------•- Address.----•--•---•-----------------•--•----••------------• Phone-----------........................ i _-i0c,- Contractor's Name_____"_________________ Motel ❑ Other- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer �. � Number of living units: __� Number of bedrooms %-.?--- Number of baths -------- Lot size _-------•- Depth to Wafer Table -------- ft. Water Supply: Public system Community system❑ Private ❑ p Clay ❑ Adobe ard`pan ❑ Character of soll to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam C1Cla y Loam ❑ Previous Application Made: 1Vf yes,date-------_------------) No ❑ New Construction: Yes ❑ No E] FHA/VA: Yes El `No El TYPE OF INSTALLATION AND SPECIFICATIONS: 'I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l ' Distance from nearest well-----------------Distance from foundation- Materia- - Septc Tank: Noof compartments--------•---------------- Size--------------------- ---- q--i-- depth = Capacity_______________________ nce I Disposal Field: Distance from nearest well-------------- --D.-Distance ofrom line foundation.-_..., ---=: -•-_Width oftfrench est lot line.--_------------- Number of lines----"---_ ' Type of filter material,_ _--------------------Depth of filter material-----------------------Total .length___-___.---_. Ile Seepage it: Distance to "rieares#well_=_-----L+nin material Distance foundszenDsame+� •--.Distance to nearest lot line .------ ❑ Number of pits:____--__- 9 1^ v3 Cesspool:--_ Distance from nearest well___ ___________ Distance from foundation._. -- Liquid Capacity----------------------------gals. . 1 ❑ Size: Diameter-----------`---------------------------Depth_._"_------------------- -------- :. ------------= ----------Distance from nearest building------------------------------------------ t Privy: Distance from nearesf well_}.__-- ---------------- --_- Distance to nearest lot ine--------------------------------------- Remodeling -------------- ------ - - -Remodeling an /or repairing (descn e):__ ---- - .. ------------------------- __/ --------------------•-------- ---- 41�. � I hereby certify that I have pre red this appii on anWhat +hea work will be done in accordance with San Joaquin County. ordinances, State laws, and rules and regulations of ,San Joaquin Local Health District. ¢ _______(Owner and/or Contractor) - ------- ---- - ---- ------- (Sig (Title) --------------------------------------------------- --- ---•----BY: - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------ DATE---.".�_ -I-�I- f-------'---------'----- APPLICATION ACCEPTED B _-. =- ----- ------- ------. DATE. - ----------------- REVIEWEDBY------------------------------------ --- - ----------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------- --------- -• DATE..------------------------/•---------------------------- .� -------••----- ----------•--------------- •- Al+erations and/or recommendations:.____""----------------- ------ ---------------- -------------------- i ------------------------- - ----- ----------------"------ - f ...: "-"" --- - - --------------- } , - � Date_ 0V FINAL INSPECTION BY ` ---------"-- F/ SAN JOAQUIN LOCAL HEAL DISTRICT" 3 124 Sycamore Street 205 West 9Th street 130 South American Street 300 West Oak Street Stockton,confornia Lodi,California f Manteca,California Tracy,California 3 E6.9 REWBEO e-99