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► _ FOR OFFICE'USE /I �, Permit No. ..J_- _5.. s ------------------ 0-3---- / APPLICATION FOR SANITATION PERMIT -•-------------------- (Complete in Duplicafe) Date Issued _-67A, --- -------- --------------- --------------- : "-- This Permit Ex ires 1 Year -------- ------ - `.From Date Issued ----- -- l Application is hereby made to the San Joaquin Local Health District for a permit to construc�a/ninstall t{he work khherein escr' This ap lication is made.incompliance will County Ordinance No. 549. t o4 4.'-dam... G[� --------- I `- ' JOB AQDRESS AND LOCATION__.......... ..... Ph Y Y` - --=------------------------- ------- Owner's Name Y, - ---------- - --w ----------------------------------------------- I ----------- -------- -------- Address.=--------------------q f-�--------------�-----•- - ---- ---:----•- ---------------- - -----------.. - ---- --------------- Phone.. ( �/ Contractor's Name...------••-- �" Motel [3 Other E]Installation will serve: 'Residence. �" Apartment"House C3Comme{tial ❑ Trailer Court El g ` INumber of living units; _j Number of 6dkooms _J--- Number of baths __Z__ Lot size --------7-- Water'.Supply: Public system❑ Community system [I Private [Depth to Water Table - ft. ! ❑ y .Adobe Hardpan❑ Characfer of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Cla ❑ '� Previous Application Made: (If yes,dote._-..----_-:----,----) No R- New,Construction: Yes e- No F1FHA/VA: Yes Q No [ � TYPE FOF INSTALLATION AND SPECIFICATIONS: . [No septic tank or cesspool permitted if public sewer is available within 200 feet.) X17 4 _� - v-- aea ----- Se tic'Tank: Distance from nearest well._.�a-_------Distance from Liquid depth....... ......... R i a p � f,.oindationq._.__12............Matarfal..-.-'- iCapacity' �'�a No. of compartments-....';�_-.._..._....size. � r �-,_---.-.-Disfiance to nearest lot ina... .......... Disposal'Field: Distance from nearest well---j—-_ Distance_f.rom foundation.-� Width of french --------- J Number of lines--------_---�----------------- Lengt ,of each line--------- -- -----7-f` ---------- o� A Depth sof filter material._./. � ----------Total length.'_ � r Type of filter material----- .-_ -= r ;,>F ; -� i � - - / c-_-__...-.Distance`to nearest lot line................. 3.. np • g meter...-••-------'-Depth...-- ------ ------ { . t Seepage Pit: Distance to pearest well..l_..-_-..._...-_Distance from oun anon_.._._- Number of pits------ -_, Linin m'atenal_.�a'-f�--- =Size: Dia Cesspool: Distance from nearest well-..-..----'_-_..'DDiiest hce from foundation------_-.._..._-..Lining matena,L...................... els• .__-.-.Li Liquid Capacity 9 q ' p tY -------- P., s: �% - from nearest well--'--. -----------------------Distance from nearest building._:__..-_--------------------------- - - ize: Diameter------- -------------- 'i ---- Privy:, ------------ ------------------------ -- -� --------------} ❑. Distance to neare f e--------------"------------- }.. .�._ . -------------------------------------- -------------------- Remodeling and/or .repairing (describe�:- E6 ----=-------- = ---------------------------------- --------------------- ------------k-- ¢ `''' ----- ------------------ - - s i -= - ------------------- ---------- ------------ ------------ - --- I hereby certify that I have prepared'this application and that the work will_be done in accordance with San Joaquin County ordinances, State laws; and rules and regula+ions of the Joaquin Local Health District l i g .._.[Owner and/or Contractor] (Signed ' R ----------- - --------- - i TI - -------- ------------------------------ -- -------------- i `By:---------- ------ ----------- :e} (Plot[ plan, showing sise� of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 y • I/- ------�-------- -------. - - ---- DATE ACCEPTEDBY------ --- - ------ -- - -- --------- --------- --- ,:_,.,,....,..�-.,....._ -- - - --------------------------------- DATE------ �------------`--------- ------------------------- REVIEWED,,'-BY ---- ----------WED. BY-------------------------- --------- ----------------------- -----I----------- -------------------------- iREVIE _ DATE--------- ---------------------------------------------------- BUILDING --------------------------------------------------BUILDING PERMIT ISSUED-------------- ------------------------------ :--- ----- ------ ----- t --- i`f- � � _ Aiterationsvand/or-wspmmenda.ions:_--._fes. 9---- c ,�. - _ - '----- v-�, -a�`. "G� r, �`----- ---A4----- --e"J' `ter-t�/-! -------- ------- I. -------------------------- ......................................_-...__.........-.....-.._--....--..-...._.................-_... ...-. --------- ------------------------------------ --------- FINAL INSPECTION'�BY:-�---- --'�---�� - -- - -------- AN JOAQUIN=LOCAL=HEALTNDiSTRICT 300 West Oak Street 124 Sycamore Street 205 West 91h Street 1601 E.Haselton Ave. t-. Lodi,California Manteca,California Tracy,California Sfocklon,California � �-••�-�»�..�. 1,, � "� i c F.P.CC.