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Permito. -— N ---------------••--- r- �'V1 APPLICATION FOR SANITATION PERMIT 1� ` . (Complete in Duplicated Date Issued --------�---- +' is hereby made to the Ser Joaquin Local Health District for a perm's# to construct and install the work herein described. Applica son Y This application is made in compliance with County Ordinance No.ae 544. v � �-' ----------------------------------------------------------•------ JOB ADDRESS AND LO ATION_.__ - - --"--- Phone--------------------------------•--- -'` • -C�---- ------ ------------- Owner's Name-------•• ANY f 4 ---------�------� --- - - -------------- - q �L� ' ---------------------- 7 Address -•-�----•-- l on ` Ph eT�" Contractor's Name__.__"--------- ----- --• Motel Other ❑ A artment House ❑ Commercial ❑ Trailer Court ❑ ❑ Installation will serve: Residence ❑� P 1 --__"__-"---------------- Number of living units: ___�Number of bedrooms __�—�Id"umber of baths __�__-- Lot size .-_-�------------------- Private ❑ Depth to Water Table .[oft- Water Supply: Public k system � Community system ❑ Clay Adobe Hardpan ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Y ❑ �. Character of soil to a depth of 3 feet:1 Sand ❑New Construction: Yes ❑ No Previous Application Made: Yes ❑ No Q`— TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepc tank or cesspool permitted if public sewer is available within 204 feet.) ti I istance from nearest wei!-_,"__.___._____Distance from foundation__._-___"--.------Material------------------------------------------------- Septic -•---------" " Septic Tank: Size Liquid depth Capacity ❑ jof'+compartmenfs____---"" -_ th of each line Width of trench----------------------------------- ' Dis osal Fie D15'a�`e from nearest well........ _-"--_Distance from foundation_-__--__"_---_------Distance to nearest lot ine_______.-------• p -- ------- •-"•.- s ❑ . ',berJo-lines---------------------- LE�g - =Total length f Type sif'♦ilter material Depth of filte r ram #oundation:^_�_ •.__ ..Distance to nearest lot line____ ----- ' D'ssta :a!/De pt -- f Seepage Pit: Distance to nearest w li._."yl )SSHze: s meter ----- p f v Linm mat rsaL _ F n Number of pits__"._--- -- 9 �`- ' Distance from' wei4"__"_"_"__.___"__Di ce from foundation_ -_--_--__"--_.Lining materia4""___".._____----------------- Liquid Capacity_ gals. E Cesspool: = ---Depth-----:-`------ --------- Size:, = Y ❑ Diameter----- ------------ ---- - Distance from nearest building------------------------------------------ 0 Distance from nearest well....--"_"_--- ------------------- O - --------- ❑ Distance to nearest lot ine�..".______--__-_-- - --------------- Remodeling and/or repairing ( e�cn e ---- ------ ------------------------------------ -----•-------------------••------- ----------------- ----------------- k----------------•-----------------------•----------------- be I herebycertify t l have prepared thin and that the s applscthe San Joaquin Local kHeallth Districts accordance with San Joaquin County ordinances, Stat laws, nd rules`and regulations of 1 .�_ •" '' �� _ ------------------- er and/or Contract (Oyrn d/o or �.1c.__ -1.�-' (Signed)----- ---- �� j d-------------- ----------------- ~ r f Title---- - -- = By: f es!'-' = to Plot Ian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r --- DATE__ ---------------------------------------------- APPLICATION ACCEPTED BY-#---------------- - - --- DATE------- --.-. cp•---------------- --------------------- REVIEWED. BY = ---- ------ -----==---------------------------------- DATE---- --------------%t -----------*-------------- ------------- BUILDING - ---- %t -------•-------------------- BUILDING PERMIT ISSUED -- -------•-------- ----- -- --- ---- Alterations and/or recommendations------------ • _ _-"-_•--•___.--_.-"_"________________ -'i---'--•-------•-- ::::::: :: : :: --:_;, ::::: -::: :: -: ::- - -: :::::::::::::::::::::::::::::::::::::::::::::::::::: •--------------------•--------------'------- / 2- /.�L - ------- Date_ FINAL INSPECTION ------------------------------------ -":. 'F- BY.___-_ _--; , SAN JOAQUIN LOCAL HEALTH DISTRICT 132 sycamore Street 814 North "C" Street 300 West Oak Street Tracy, California 13o South American Street Lodi, California Manteca, California Stockton, California I �9�2M ""G ATWOOD 12 54