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FOR OFFICE USE: �. ----- - Permit No. -f --------- APPLICATION -.�--•-- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) - ---- ------ - Date Issued --------------------------------------- -- - This Permit Expires 1 Year From Date Issued -------- -------- - -------- ----- ----- -- ----- Application 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 o. 49. 0-111%/ G 77 - JOB ADDRESS AND LOCATION-_._-- j /� Phone..-----� -- --•- -- --- --� Owner's Name---•----E3-iLL---- i/ --------------------- f� ------------- Address p --------- ------ -- - ---------------- Phone4.-- k-/46�7--- - Contractor's Name---- --•--•1 .--- -- -- - r} E] Motel [3 Other Elj Co il T Installation will serve: Residence K Apartment House [ICommercial ❑ Trailer u r �/ -! -©--X f--$-r-------------------------- Number of living units: -1----- Number of bedrooms - . _ -_ Number of baths I------ Lot size Water Supply: Public system`o Community system ❑ Private ❑ Depth to Water Table-�►' _ ft• Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe A Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ Y ; No New Construction: Yes [IPrevious Application Made: (if yes,dateNo FHA/VA: Yes ❑ No 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-----------------------------.------------------ ❑ ES'Fl No. of compartments Size --Liquid depth--------- ------ ------Capacity----------- ----- p , r N� � Disposal Field: Distance from nearest ws}/4�/UO+�4�---Distancs from foundation--l�___--------Distance to nearest lot line. -_-----. Number of lines-___C��-s - j.. __.__ ----Length of each line---Vis__--- Xc----- Width of trench...-�4-.-r-------------.... g 3 Type of filter material_ Depth of filter material_...._ _-- ___---Total len length -_-- _ r i r �,�-_-----.Distance to nearest lot line--.. - I Seepage Pit: Distance to nearest well-.- .�i��_Distante rom undation-__ �K Depth �-� � /� _Size: Diameter--- --- Number of pits- ------- 54 -- L Lining material. ./ Cesspool: Distance from nearest well-----------------Distance from foundation----------------_._Lining material-__.--.-.__--_..--__.__:.--_____-.__- ❑ Size: Diameter---------------------- --------------Depth------------------ ------------ --------------------Liquid Capacity----------------------------gals . I Privy: Distance from nearest well----------------------- ---------- -- ------ Distance from nearest building--------------------------------------- -- ❑ Distance to nearest lot line-------------------------------------------- ------------------------•----------- ` Remodeling and/or repairing (describe):- ! --------------- ------ -- ------------------------------ -- -------------------------- ------------- --------------------------- -----•---- ----- -------------------- - &_ -- --------------------------------- -----------------------------------------------------------------------------•-------------------------------------------------- ------------------------------------ ' I hereby certify tha he a prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd r es and regulat' sof the San Joaquin Local Health District. -_ ---------------_--- ------ - ..(Owner and/or Contractor) -- --- ------ -----s (Signed) r -- ------------(Title)--------- - - (Plot plan, showing size of lot, location of system in relati to w�i �uildings, etc., can be plated n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --------- - DATE------1--- ------4K' ----------------------- DATE. ----------------------- DATE------------------------------------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------- DATE-------------------------- ---------------------------------- BUILDING PERMIT ISSUED---------------------------- ------------ -- Alterations and/or recommendations:__--2 -------------------------- ------------------------- ---- ! - --------------- ----- -- v�;�,g; Z ----------------------FINAL INSPECTION BY ----- -------------- - - ------ ------- °-------- Date -- ------- ------ - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Kaselton Ave. 3oo West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California Manteca,California Tracy,California Stockton,California - I F.G.CC.