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1 APPLICATION FOR SANITATION PERMIT Permit No_ ------ ________________ (Complete in Duplicate) 7 �?_f_-/ fy Date Issued ____._� f0 ' Applica�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ #2moti ------FQ-R1(.----- n. z -------- Owner's - - Owner's Name----------- ---------1 Lv- c4'rL Y------- ------------------ Phone. - ----------------------•-------- Address-------------- d -----... j---- Contractor's Name------ ----- -•--------•----------- Phone------------------------------------ Installation ------•----------•---------- --- -Installation will serve: Residence U�__Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ . Other.❑ Number of living units./------ Number of bedrooms _.,.Number of baths ---/ Lot size ____.__- _.. __________________________ I Water Supply: Public system ❑ Community system E}---Private ❑ Depth to Water Table 6---6 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado6e,0Z Hardpan ❑ Previous Application Made: Yes ❑ NNew Construction: Yes RNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___- _.___Distance from foundation------/!_____...MateriaL____6�__C�_491-11-1a_ Ste---------- -------- _._. Capacity -- 'No. of compartments----c= ------------- Liquid depth______. Disposal Field: Distance from nearest wefi1-2 "_-Distance from foundation'__._Je__'-__.Distance to nearest lot line------- Number of lines---------- -ft-------Length of each line--------- ........_ .Width of french------ V-- ------------- Type of filter material _.��Depth of filter material.._..._. _�_�--Total length___.-_�_4_ ------------- r Seepage Pit: Distance to nearest well_ --------Distance fr m foundation_.6- 4_f......Distance o nearest lot line-----J .__ 'g Number of pits------- Lining material-_-- g_��Size: Diameter----_3_3_......Depth __--._.___. Cesspool: Distance from nearest well_________________Distance from foundation___ ----- Lining material-------------------_------------------ Depth __-___-Li Liquid Capacity El Size: Diameter-------------------------------------- p ----- ---- --------- 9 p Y---------------•--------•---gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________________________________________ ❑ Distance to nearest lot fine- ------ -------------------- -------------------------------------------- Remodeling and/or repairing (describe)- ---------------- ----------------- -------•---•---------------------------•-----------------------------•--------•------------------••----- --•--••-------------••-•--•----••---•--•-•--•--•-------------------------.-----------------------------------------------------------------------------•----------- -- -------------- _------------------------------- �} -------------------------------•--- -----------------•------•---------••--•----------•----•------•----•--•----------•-----•--•--•---•----..._------------•--------•------------------•-••------ ---------------- . I hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin County �. ordinances, Stat . and rules and regulations of the San Joaquin Local Health District. 7 (Signed)----;s5owiin� ----- - --------------- - -- ...... s--------- "_--------------------------------------------•------ ---(Owner and/or Contractor) By:- (Title) -- - -- - (Plot plan, size of lot, location of system in relation to wells, buildings, etc., can be placed o reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_„ ... - - DATE_"' - -- 1KI REVIEWEDBY-------------------------------- .----------------------------------------------------------------------------• DATE- �. BUILDING PERMIT ISSUED------------ ------------------------------------------------------------------ -------------------- DATE.------V!-------------------------------------------- Alteratioon)s and_Zor recommen too s:.---- i----------------- ----- ---- --------------------------------------- ---- --- ------------------ - FINAL INSPECTION BY;--- ---a------------------------------------- Date.---.-1-'---1 .` 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--S 145446 ATWOOO