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FOR OFFICE U E:. Permit No. '? it 7 f__G � ' APPLICATION FOR SANITATION PERMIT - - --------- (Complete in Duplicate) w �-.--r Date Issued -. _.� ------ ---------- ---- --------- -._------- ------ -, * _- ,. - This permit Ex" fires l Year From Date slue •- . Application-is hereby made to the San Joaquin Local Health District for a permit to construct and ins}all the work herein descri a This application is made in compliance with County Ordinance No. 549- This .. -------------- ne. ----•-- tCATION_. '- --------- ._. PhoDLO -- JOS ADDRESS AN ---- Owner s Name--- --- Address. ----- = •----•-------------- '� 2---- --------- =f_ __f1 Motel ❑ Other Contractor's Name-_._-�__-_�----- , Commercial ❑ Trailer Court ❑ Apartment House ❑ --D ...3_ca-,c-------------------- Ins}allation will serve: Residence 0 P x- Number of living units: __ --- Number of bedrooms .-.- Number De} to Wateo Table Z - ft. Priva#e ❑ P Adobe❑ Hardpan ❑ Water Supply: Public system. Community system ❑ Cla Loam J] Clay ❑ Gravel [ISandy Loam ❑ Y F1iA/VA; Yes ❑ No Character of soil to a depth of 3 feet: 'Sand ❑.�- )�11- New Construction- Yes [I No ® 4 Made: (If yes;da _ te ----------- Previous Application TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r f : Q--._.__.Material.__-- """ _ _ Ca acity---• ----------- 1. . i Distance from. nearest well-.____-------Distance from foundation depth__.____-y --------- p Septic Tank: ._.__ sr No. of compartments----------- Size----- Distance to nearest lot line____.__. .Width of trench.---------- ---------- ---�_\ Disposal Field: Distance from�neares} welL___...r--~---:Distance from foundation ,-'---- � th Number of 4ines` ---- ---------Depth off filter}material_._.._ -Total length r� T e of filter material-------------- p .. Yp ,3 _ , . t t _. Distance fr m foundation_..�-�-tea-�+sten`e to nearest o#� Seepage Pit: Distance to nearest:well-_--_. Size: Diameter- --- . Number of pits.__.__ - . - Lining material__ gals.Distance from nearest well_____-------I--:Depth-. et+hce from foundation_-,----_-.:::_:::_Liqu'id'Capaa#y--.---------------------- ()als. Cesspool ---- p ❑ S,;ze: Diameter----------------------- : -Distance from nearest building--------------------- D;stance§ Distance from nearest well--------------- -' ------=--- -------------- ---- ----€- -- r - i ❑ Distance to nearest lot fine____ -- 1 ------ „ . Remodeling and/ re inng des�nbe�: -------------------"•------------------------- 4 - - ------- r F --------------- --- ------- - "" --------------------------- _ __�---------------------------------- __.___.__.___. .._.:____--_ ---"- ,application and that the work will be done to accordance with San Joaquin Coun I hereby certify that I have prepared t is app ordinances Stat aws, sand regulations of the San Joaquin Local Health District. or Contractor) I . ~% � -------(Owner and/ ---- ------------------------ ---- ----= -- (Signed)-- � - , �. ed on reverse std ' ----- ---- -----(Titl -------------- --------------- --- : e_ gy_____________ buildings. etc., can be plat side). (Plot plan, showing size of lot, location of system in relation to wells, , F DEPARTMENT USE ONLY r DATE------------ • --/ ---. _/: . ------ APPLICATION ACCEPTED BY--------------- ---- --- -- ----- `--- � ----------------- - DATE-------------------------.... ...................... ..... DATE------------------------- -------------------------------- REVIEWED BY--------------------- - - ------=-------------------------------------- - -- --------------------- DATE----------------- ------------------- ----------•--------- -- - ----------------- BUILDING PERMIT ISSUED_.'. _ -=--- ------ ------- 4 .. Alter tons and/or recommendations:__- ----`----- � --.•----,_--" l-1-�`� -f'r' --- --- ---- ------- ------------ ---- - ,� Date------- --- -------T--- ----- -------------------------- FINAL INSPECTION BY:.`"� . --- -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 9+h Street 124 sycamore Street 300 West Oak Street Tracy,California 130 South American Street Lodi,California Manteca,California Stockton,California E9-9 pEVIOED 0.99