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~ -- Permit No. ------------�- # APPLICATION FOR SANITATION PERMIT in Duplicate) `" (Complete P � Date Issued n Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the Sa This application is made.in compliance with County Ordinance No. 549. f ----- ... ... -- -------- JOB ADDRESS AND LOCATIO`N,__�,�, y-- - / -Cl � =-------Z -----------=- Phone---------•--------- Owner's Name-------- ---- -----x--. / --- . _ ." f= `' --� ----•-------------- = 1�z, f Address- -----------------------••---- � �7Z/ Contractor's Name_____ � y------ ' --- Phone-?_/ - � Motel ❑ Other ❑ Installation will serve: Residence 59 Apartment House ❑ Commercial ❑ Trailer Court [:] r � �� e�� Number of baths : '-_ Lot size ---�_.4-----x----•1•14�pr------- of living units: __rf'"`- Number of bedroom private Depth'to Water Table�ft. r Water Supply: Public'system [Community system ❑ ❑ Character of soil to a depth of 3 feet: Sand T-1Gravel [-] Sandy Loam ❑ Clay Loam [3Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: Yes 171 No F1 New Construction: Yes E] No El FHA/VA: Yes ❑ _ No ❑ E Via(.: -c & TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Se�rc Tank Distance from nearest well________________Distance from foundation_-.-----------------Material__-___.________,___------------------------------ No. of compartments------ ------------------Size------------------------•---- Liquid de�th Capacity- No. to nearest lot ��y � Clisposal Field: Distance from nearest we .... ___Distance from foundation_. , Width of trent ._ f/ "V �-- - - -------- ------Length of each line--- ---------- ( Number of lines - -- - y i �? � Type of filter material__- - �*-- - Depth of filter materi -----Total len th__- c- -� r Seepage it: Distance to nearest well____l�_ s ---Distance frim fo ndation__ ��_--...Dis Oto nearest lot line__.___.�0_-.-. 1 /R C�'�-- Size: Diameter Depth ' '� '. [�- Number of pits___:__#�--:-------- material_-.�_ .- --- (' Cesspool: Distance from nearest well_________________Distance from foundation---._-._______:__-_.Lining material_._________.___----- els. ` ❑ Size: Diameter------ --------- --------------------Depth---,--------------€---------- _ ,-----Liquid Capacity.._._- g k -----------J_----Distance from'nearest building------------------------------= -- Distance from nearest well______-___.__------------ -- -- *1 Privy: _ .....,.. .,.- � : - -------------•------------------- -- l` - Distance,to nearest lot ine________________ _ ----_ ,- Remodeling and/or repairing (describe):------------------------------ -----•----- ----------•1---•-----------•- ---------------------------------------•----------•---------------------------------------------------------------I------- -------••----•---------------•----------------•----------------- - ----------------------- l ----------------------=-•---------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ' ordinances, State laws, and rules nd regulations of the San .los ui�Local Health District. !., 1 ' ---------------------_- nr.Contractor) --------- ------------------------- (Signed 1 ° [Ti+lel (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., . be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY----------- -- ----- DATE ;� DATE- -- ,� REVIEWEDBY--------------------- - ; '1 -------------------------,-----=------- - I. h BUILDING PERMIT ISSUED—------- - ------ --------- •----- DATE, _ /rr ] �- -- -`-C------ ---- + Alterati ns and/or recom nda 1 ns:__ - -� -�- ! -- f � FT ' e7 L'C? C.- L3� -----4-------------------•---------------- I t r4 - - C�La �+ = j �"tfp� rt ------------ - - A --- •--------- --------- Date-------- r -------------------------- - -- ------ FINAL INSPECTION BY:------- SAN JOAQUIN LOCAL HEALTH DISTRICT F132 Sycamore Street 814 North "C" Street 130 South American Street . 300 West Oak Street 1' 'Lodi, California Manteca, California Tracy, California t} Stockton, California h ES-9-2M , Revised 1.57 FYCO. ---