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1cif 6 < APPLICATION FOR SANITATION PERMIT Permit No. -- el (Complete in Duplicate) Date Issued ---- ---- - - ------- Applica"ion is hereby made to the San Joaquin }�Coun#caO denanceDlNo. 549.a permitconstructawn a he.work herein described. This application is made in compliance y JOB ADDRESS AND OCATION....fY.-Pr-._ - ':6!- r---- ' -------------------------- ------- Phone -- -- - Phone----------------- ---------•------- Owner's Name--- -A • ----• -•--- I l�l S G--� L ° !Gv ----------•--------------- Address_.--------•-= °------------ - Phone-•----------•--------•------------- �JQX I.S/Y-----�1IC�.r.._ ------- ------ Contractor's Name___ _____ _________ _ ___ Motel Other ❑ Installation will serve: Residence ©�Apartmen# House ❑ Commercial ❑ Trailer Court ❑ ❑ Y..Lot size ----1-- CCN •------------------------------ Number of living units: -1----- Numbef bedrooms ---�ate be��ba ------ Water {Q Water Table _C�r -eft. Water Supply: Public system ❑ Community y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe JJJardpan ❑ Previous Application Made: Yes ❑ No © New Construction: Yes [�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r b_- ___Distance from founda __-_1_.C}._-__:_.,Mafienal___��_-+��!---�---------= -------- -ion 5epfic Tank: Distance from nearest well____. �. Q � r� fr ❑I' No. of compartments-----�--�-Q--- --- Size__5.�---�-- -��----Liquid depth =---=�=�-------- ---CapaatY-- --- ---�--�----- Disposal Field: Distance from nearest well-..:�-r.-Distance from foundation_-_ _a--•----Distance to nearest lot line----,I__________ of lines-------------- ---------- Number ----------Length of each line------_—rd- .... Width of trench----�?SiT----------------- -------------- -------------- (— '' !_ Type filter material---�4----S.X Depth of filter material--- Distance length-------- �- -------------------- 7�..__.__.Dsstance #o nearest lot line__._�J___..___-_ 09 Seepage Pit: Distance to nearest weli_.l_0�--.-------Distance from foundation.__ �� _ � Number of pits._.__-__l_.-...---Lining matersal__ T._C-X-_Size: Diameter___.3___ ______Depth.--__ ...__-______- Cesspool: Distance from nearest well-----------------Distance from foundation.___---------------Lining material---------------_-._--___----------- - ❑ Size: Diameter-------------------------- -----------Depth-------------- ---- -------------- -------- --------Liquid Capacity----------------------------9 Privy: Distance from nearest well_________________________ ----------------------Distance from nearest building------------------------------------------ Privy; -----•--------------- Distance -------- - ❑ ------ - ----- ------------------------ Distance to nearest lot ine._------------'----------- --- f� C j L ---••-------------------------------•----------•------------------------------ Remodeling and/or repairing (describey:-------1 e ________s _l- --- ------------- hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State S. and rules and regulations of the San Joaquin Local Health District. ner and/or Contractor) ---- ----------( 9 )--------- (Title)-----AIF- ---- ---------------- (Plotplan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). BY: FOR DEPARTMENT USE ONLY �� DATE-------�----------------------------------------------- -------------------- APPLICATION ACCEPTED BY DATE----------------�-- :------------------------------------- REVIEWEDBY--------------------------------------------- ---- -------------- --------------------------------------- BUILDING PERMIT ISSUED------------------------------------- --- ----- - DATE----- ------- � _ = ------- -------- ----------------------------------- ------------------------ -- --------------------- ----------------------------------------------- ------- Al+era+ions and/or recommendations----------------------- -----_--------------_ --------------------------------------------- __-_ _db---- - -' V------- ------------------------------- - ------------------ Date .-r.....1. r --------------- FINAL INSPECTION BY:------- .- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 30D West Oak Street Lodi, California Manteca, California Tracy, California Stockton, California ES—S ins-0A6 PTWCOD