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_�...a..� ,m`.�. �.--.�.�sa�«�"' - - FOR OFFICE USE: Permit No. ... o=sem" " APPLICATION FOR SANITATION PERM IT l- [Complete in Duplicate] Date Issued __ '- -•------ --- -----.-- This Permit Ex ires l Year From Date issued ---------- A Application is hereby made to the San Joaquin Local Health District for o a permit to construct and install the work herein described. pp This application is made in compliance with County Ord `` 1� I JOB ADDRESS LOC Tff� ION-- k ,� ------; Phone W@ !F_ _ Owners Name------ - ---- ---- /� "-- I AddressQ.... - ---- -------- - � Contractor's am --- ----------= Motel Other l Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Number of bat s _�'"Lot size _ �� ------- Number of living units: _ -- Number of bedroomsvate epth to Water Table _. - t. Community system ❑ Water Supply: Public system ❑ Co Y Y Adobe ardpan ❑ Gravel Sandy Loam ❑ Clay Loam ❑ C ay ❑ i Character of soil to a depth of 3 feet: Sand ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ Previous Application Made: (if yes,date_._._ No ❑ I TYPE.,_OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest welp_------ Distance from found n.__., ---- Material--- "�----- �$�c Tan r 't-capacity----/Y �Y 7 No. of comparfiments... -- --- S'sze. 2�--��Liduid depth .._f -- t � �� -..Distance to nearest lot line..__---•-- Dength offrom each linfounet/r TotalWidth 4ength trench. Disposal Field: Distance from neare we -- Number of lines. - Type of filter material____. _.____._ -- - .-Depth of filter materiaL_...�� � r Distance to nearest lot line- ------------- � r_. "Distance om f undation_ _. �� r 3 SFeage Pit: Distance to nearest w ll__,l-_ De th._,-- V -- p __Linin material_ .__.__ Size: Diamefer._. s Number of pits------ g _ •E_.- als' pool: Distance from nearest well -----_-_ --Depthce from-------------------- .oundation--- ------------ Liquid-Capacity-:Lining material ---------------- -----•-'-9 --- F ❑ Size: Diameter---------------- Distance from nearest build'ng._------ -------- Privy: Distance from nearest well ----------------------------- �. ❑ Distance to nearest lot ine._--_----.,----------- �p -------- --- Remodeling and/ re airincnhe} _. is sc�c ---------------------- ------------------------- _---•----------•----------------------•--------------------------------------- ----------------------------------------------------------------------------- - - ------------------------------------- -- -- - o done I hereby ce that l have prepareduthis lat ons Ili ate San Joaquin hat the wo Heal heDistrictn accordance with San Joaquin County ordinances, St�a la s, an rules and re i l Q C'� ontractor) ------------------------------- --- �'- (Signed)------- - -------- T_ ' (Title) - - - - --- -- By:--------------------------- -----------------------y---------- ----- can be placed on reverse side). } [Plot plan, showing size of lot, location of system in rela, n to wells, buildings, c., FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B .......... ' --- ------- ------- -------------------------_ DATE------. /---- ------ ------ -------- ------------ DATE-- -----------DATE_. ----------------- ---------- REVIEWED --------- ---------- REVIEWEDBY----------------------------------------- ----------- -.-- DATE------------------------------------------------------------ jBUILDING PERMIT ISSUED--------1�W4�-:---- � --------•------------------------------ ------------------ Alterations and/or recommendations:.. I --------------------------------------------------- --- ------------ --------------------------------------------I ------------------ ----- - ------•--' ----- --------- --------------------------- --------- ------------------- ---------- ---- t ----- 6 ----- --•---- �� /� Date!/--�-�� -- - ------- ------ --------- ------------------- ---- FINAL INSPECTION BY: SAN JOAQUIN LOCAL HEALTH DISTRICT 124 sycamore Street 205 West 9th Street 1601 E.Hat:ellon Ave. 300 West Oak Street California Lodi,California Manteca,California Tracy, Stockton,California r•,P.co.