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FOR OFFIC USE: (� r , — f `�^ Perm}# No. -'- APPLICATION FOR SANITATION PERMIT r -- 1�- ----------- ---f (Complete in Duplicate) Date Issued ------ ---------------- ____- __ _-._._ This Permit Ex fres 1 Year From Date issue Application is hereby made to,the,San Joaquin Local Hdealltn �DiNoc for a permit to construct and install the work herein descri ed. This application is,.made in compliance with County Y- 4. ------------------- ! O��.1v-----------•---------•------- JOB ADDRESS'AND• LOCA] N... �P_ _ r Phone-------- ------ -----•-------------- i``•,.S � lY�- ----- - ------------------ Owner's Name-------------------------- -- ""__.' = J Address---------•------------------------1-----,/'Y-! R = one-----------------------•---------- �� - ------------------ Contractor's Name-------------------- tc' Motel ❑ Other ❑ c Commercial ❑ ,Trailer Court ❑ r Installation will serve: Residence IX Apartment House ❑ 1 (� -units: .. _.. Number of bedrooms --/--_ Number of baths _s - Lot size /t •----- Number of,living Depth to Water Table -------- ft. Water Supply: Pubhcsysemy Community system Private ❑ Adobe Hardpan ❑ Gravel Sandy Loam ❑ Clay Loam ❑ C1aY ❑ No ❑ Character,of soil to a depth of 3 feet: Sand ❑ New Construction: Yes No ❑ FHA/VA. Yes Previous Application Made: (if yes,date-_-----------------1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septict'#ank or cesspool permitted if public sewer is available within ion feet.) ..�� -A�-- -.Maters I---- --�-��- - 5e tic Tank: Distance from nearest well.- /�U/�Distan5 m -foundation P Size.:�__�/ F�X.C�.�_:Liquid depth------- Z! Capacity. ISYGYJ- No. of compartments-.-_.-�--------- 1 __ -�...Disfiance to nearest lot line�------�{.-.-_-- Disposal Field: Distance from nearest well-.. �Denath ofrea h 1 ",��°,°~ _ r idth of trench.._------�/ _ Number'of lines - g 1 Tatal ��ng}h 9�----------------- ------- ---------- f h Type of filter material..__. --. -._ — Depth of filter materia4___/- -------- r'lX- Distance m oundation---gf './"--_--.Distance to nearest lot line------ _---- Seepage Pit: Distance to nearest well__ _ _______ _ _0 P Numberlof pifis---�•---�------Lining material- ------=----- _Size: Diameter_----- �---------.De th-------.,2-�`•---•------------- { --------------------------------------_ ' Distance from nearest well --------------Distance from foul ion.--.----------- ..Lining materia als. Cesspool: :. ------------------------------------` ------Liquid Capacity----------------------------g ! ❑ Size: Diameter---------------------------- Depth_ --- YDista ce from nearest buildin g-------------------= - Privy: Distance from nearest well------------------ -------- ---------------------------- t ---------- ❑x t J . ...................•--------------------------------------- Distance to nearest lot line - 1 Remodeling f n-' I repairing {de f /LC --•-- - •--•------- -Z-------'------------------------------------ -- i hereby certify that i have prepared pareduthi ons application the San Jaaqu n Local kHeal heDistr c+n accordance with San Joaquin County ordinances, State laws, and rules a 9 C }r } r on ac or J (Signed) (Title)-- -- ----------- -------------- ( By:--------- ------=------------------ - -- Plot Ian, showing size of lot, ioc of system in relation to wells, buildings, eta., can be placed on reverse side). OR DEPARTME T USE ONLY t - - ----------- DATE...----.. -------------------- - APPLICATION ACCEPTED BY_. ----- ..� DATE DATE REVIEWED BY. -_-.------------- ---- ------------- BUILDING PERMI7ISSUED--------------------- ----=-------------•------------- - --- --- Alterations and/or recommendations:-._- ------ - -- - -- - --------------------- epz .. ti __ ....................... .- f ,. Date-- ----- ---- --�- ---�'- --------------------------------------------- FINAL INSPECTION BY:... --- - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street i24 sycamore Street 205 West 9th Street Lodi,California 130 South American Street Manteca,California Tracy,California Stockton,California 1 ES-9 REVISED 0-50 F:P.Co:2M 6.6C f -