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n Permit No. _ ... APPLICATION FOR SANITATION PERMIT ------- --------- (Complete in Duplicate) / - -y ---- --------- 4 � Date Issued ----•-`----'��-•--G� made to the San Joa uin rmit Ex ares 1 Year From Date Issued �.=- ------ -This Pe Application is hereby m q Local Health District for a permit to construct and install the work herreidescribed. This ap location is made in compliance with County Ordinance No. 549, r . �-/J` ' Yh��G__1�v_r.�t- �e- J B ADDRESS AND LOC TION: I,-..__ ./_✓ ------ r� ---- � '`- — ------ Phone----------------------------------- ---------------- -------------- Owners Name------ --------•----•-------•-- - Address ? --------•- ------------------------------------ ----... rf Phone--•.................•------•...---- y.L� Contractor's Name-------- --- - --------- •--- ---- -- •• •• -- - v:- i�! Motel Other ❑ Installation will serve: Residence �'Apartment;House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: J___ Number of bedrooms ._ _ Number of baths _�_._- Lot size ___ _ �• Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _ Character of soil to a depth of 3 fee+: Sand ❑'`Gravel [3 Sandy Loam [I.__-Clay Loam ❑ - Clay ❑ Adobe Z3,Hardpan ❑ s Application Made: (If yes,date-------- .___.___ -} No Tr—New Construction: Yes E] No �' FHA/VA: Yes [I No Previou pp _ - __„Y_ � • TYPE OF INSTALLATION.AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeRtic-Tank' Distance from nearest well_________________Distance from foundation-"----.-----------Materia4----------------------------------------.---------- wl-14� No. of compartments----- ---- Liquid dep••th--------------------------Ca acitY - --------------- Size__.----------------------- ---- p ----------------------- well...> �_ -.-Distance from foundation.___�p____ .Distance to nearest lot line__------- Disposal Field: Distance from nearest ___Length of each line_� F/ �-- ��' Width of trench__-z Number of lines ___________________________ , g - �r�d - Type of filter materLal._ Depth of filter materia!____/, __-----,---Total length_--�L�-----------------••----•------ _ ------ from foundation___._��!�..:___.Dosta`�e to nearest lot line__ ____._-.- Seepage Pit: Distance to nearest well-- 10_ -------- material__._t�� ---.Size: Diameter___-- -``,-----_�;Depth-----Z.3----•---------------� Cesspool: Distance from nearest well___:_:__-____.__Distance from foundation_-------------------Lining material______._____----�------•-------als. ❑ `-----------Depth--------------------------------- Liquid Capacity g Priv Distance from nearest well Size: Diameter________________________ Distance from nearest building._---------------------------- --- --- �,❑ ---------- Distance to nearest ]of :ne----------------=------------ ---------- - -- •- - Remodeling and/or repairing (describe):_________- 6 - -- --------_-------------------- }-�... , ------------------------ =----------' t------••-------•----------- ¢ ---------------- C - -- - ---- -- ----- = = � hat the work will be done in accordance with San Joaquin County I hereby certify that 1 have prepared this application and t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. • — -[Cwa d/ r Contract --------- (Signed) o or) a•-- (Plot plan, showing size of lot, location of syste in relation to-wells, buildings, etc., can ba placed on reverse--side). FOR DEPARTM T USE ONLY APPLICATION ACCEPTED BY-------- -- - ----------- DATE1=�� -�---------------- APPLICATION ------------ BY ---------------------------- -------------------- REVIEWEDDATE--------•-•---------------------------------- BUILDING'PERMIT ISSUED-------------------------------- ----------------------------- DATE------------------------------------------------ ------ Alterations and/or recommendations: ------------------------7----------------------------------------------------------- ----- _------- ---- ---------------------------------------------------------- ---•-------------•-----•------•---------- •-------------•---•---•------------•------------------- -------------- -•-----•------- ----------------- ----------- c Q------ --------------------------------- ---- ------------------------- ----- ----- ---------- �------• ` _-- ------�.._.-�-�----��---�--•vat------------------------- - FINAL INSPECTION BY__°- -- -- . . . -- -------- Date_------f --- --�j-- {� SAN JOAQUIN LOCAL HEALTH DISTRICT k.Street ; r" 124 Sycamore stre t '� , 205 West 9th Street 300 West Ga 130 South American street ti 1 l k >! . Stockton,California Lodi,California Manteca,Collfornia Tracy,California l ES-9 REVIa EO a•59 P.P.Ca.SM 6-60 - 3,'f•�� y 1; -''� }�'.,�,\