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FOR'15FFICE'USE: ----------- -------------- - PERMIT Permit No. --------------------- ------- APPLICATION FOP, SANITATION ------------------- (Complete in Duplicate) Date Issued ------ -------- ------------- -------------------------- This Permit Ex ices I Year From Date Issued - --------------- to h D con§frucf rid in all t *ascribed. Application is hereby made to the San Joaquin Local Health District for a permit t This application is m da in compliance with.County Ordinance No. 549. Nat& 0 e7l 0 At ---------------------------- ----------------- JOB ADDRESS C --------- --- Owner's N a - ------ ------ - ------------- ------- --- ------- .......0--W�------------------r---------- Phone-1/6z/:7'� ---------- 6- - - ---- ------ --------------- -- ----- ------------------------------------------------------------------------- Phone.4- 417----- .,Address- I---- -- --------- - - -------Contractor s Nam ❑ Motel [I Other [:1 Installation will serve: Residence 4--A"'partment House ❑ Commercial 0 Trailer Court Number of living units; -1----- Number of bedrooms,3.. N tuber of baths _1_.__. Lot size .....If ff. ............ Water Supply. Public system ❑[I Community system ��rivate 0 Depth f W Table Loam �� a a Character of soil to a depth of 3 feet- Sand ❑[] Gravel El Sandy Loa am Adobe [3 Hardpan C] 11-/ - FHA VA: yes E] No gt'-- Previous Application Made: (if yes,date-------- No Ur New Construction: Yes No El TYPE OF INSTALLATION AND ND SPECIFICATIONS: sewer is available within 200 feet-1 I (No septic tank or cesspool permitted if pub IN MIteria; Se fi Tank: Distance from nearest wall-0.1—i----Distance.from foundation apacit-----SP - - ------ P)T el ------ -7 6-;�-�--Uquid e No. of compartments----2-------- --Sizej .40, - ---- s< -- Distance fv t/ Distance from foundation J��-------Distance to nearest Ar st well- sK D Di I Field- istance from near Length of each,�ire---- of french-- - ----------- De-�ik,-f filter m Number of lines-____ ____-_ ---------------------- 0 74 ........ Type o� filter materi1�0( aie,7---------- Total length ------- Djstarce�'to nearest well-- ------------ --- Distance from foundation-------------------.Distance Distance to nearest lot line Seepage Pit: r-ial---------- ---------- I Depth---- ------- ------------ 0 of pits----------------------Lining material---------- Size� Diameter------------- - ------- I ? El _vra� ------------------------------ Cesspool: Distance from nearest well----------- Distance from foundation.-. -----------Lining material.. if t Depth-------------------------------- ------------------Liquid Capacity-------------------- ❑ Sao: Diameter------------- ---------------------- Distance from nearest building________________ Privy: Distance from nearest well------------------------------------------------------------ -------- ----Dist ------ --------------- :--------- ❑ rest lot line------------------------------ ---------- ------------------------- --------------------------------- Di5tance to nearest I . 11 1, - -- --------------------------------------------- --------------------------------------- Remodeling and/or repairing (describe):---------------------------------------------------------------- ------------------- ------ ------------------------------------------------- ------------------------ h ------------------------------------------------------------------------- -----------------0----------------------- ----------------------------------------------------------------------------- ----- ------------------------------------ ------------------------------------------------ ------------- --- ---- - - - ---------- ------------------------------------------------------------ with San Joaquin County --- -------- - ---------- ---- ---- --- ------------------------------at--I--have--prepared- -- --this--application and that jh k ill be done in accordance w 1,4q � I I hereby certify f� Local Health District. ordinances, I and rulg4k and regulapons of the San .1 1 -----------------I---------------- - (Signa ---- ---- - -------- -- --------------------- --- ------ ----- (Title) ------------------------------------------------------------------ By:-------------------- _. iiI side]. (plot plan, showing size of lot, location of system in relation to Is, buildings, ey- can be placed on reverse s' FOR DEPARTMENT USE ONLY -- .--6-s-------------- ------ - APPLICATION ACCEPTED BY---------T-M-=V,7------- ---------------------------------------- DATE 3 - REVIEWEDBY---- -------------------------------------------- ---------------- ---------------------------------------------------------- DATE--------- ------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------- -------------------------------------------- Alterations and/or recommendations______________.---------- ---------------------------------------------------------------------------------- ---='!�------------------------------------------------------- -------- --------------- -- -------------- ----------------------- ----------------- ------------------------------- -------------- -------- ----------------------------- ------------0-------------------I--- ------- ----------------------71------------- ---------------------------------------------- ---------------- ----------I--------------------- !I -------- A-- �N---------------------- -- ------------------------- -------I... ------------------------- ----------- ----------------- ------- ------- -------- ------ -------- -------- ---------- --------------- --------------------- ------- ------------ -------------- ------------------------- --- -- --------- 4577----------------- FINAL INSPEC - --.R-- - -- ------ --- Date------- ---- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. Lodi,California Manteca,California Tracy,California Stockton,California F.P.ccl.