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r,1,o1 �'Z p- - Permit No- ------------•-------- APPLICATION - - f4APPLICATION FOR SANITATION PERMIT t (Complete in Duplicate) Date issued s Loeal Health District for a permit to construct and install the work herein descri`ed., 0 yApspapplication lication is hereby made to the San Joaquin pP is made in com pfiance w f�'+,-r with County Or • a c1No. 549. (� Thil 1 .� IY JOB ADDRESS AND LOCATION-N _ /� -, Phone ------------ ----------- - f� ' ` - .- --------------------------------- Owner s Name----------------------------- _ .- . - ----------•-----------•---------- Address--------------------•-------•- --- Phone- ��---=�'� _. ' r Contractor's Name--------------------------------------- ' Motel , Other [It Installation will server Res'sdence� Apartment House ❑ Commercial ❑ Trailer Court E] ) ,1�� g _� Number of baths -/�-_-__ Lot size -_-. _ Number of Iwin units: ----(_ Number of bedrooms _ __ �, , th to Water Table -------- ft. -WaferSupply: Public system K CommurMy system ❑ Private Dep Clay Loam Cla Adola Hardpan ❑ Character of soil fop depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam'❑ Y ❑ Y ❑ . New Construction- 'Yes; "No FI—FHA,/VA: Yes ❑ No ❑ t Previous Application Made: Yes-E] No [� , b TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permuted ipublic sewer is available within 200 feet.) _` Septic Tank: Distance from nearest well-__-670 Distance from fout�tion---__` ---•---Material 4---_ Capacity [��- _-- k�X `f Li uid de th---.--- ``. ---------- p Y ` - q t? , No. of compartments_---_r_-_-�-___--__Size___ . #. w Disposal 'Fie{d. Distance fr m nearesf 4ell-_,. --_._.Distance from foundations_-__ W t� gfttren hestrlo�. -__-- -0 - ------Length of.each line- ;; X Number of lines-------------- g -• -s Total I'en th___--- }� Y� Type of filter material-_- -C lr.....Depth of filter material_--:-_. ---- -}- g tDistance to,Aarest lot line----------------- 0� Seepage Pit: Distance to nearest well_.------------------ Distance from foundation_______________•o 1. -.- _.De th-------------------- [ Number'of pits material---------------_ ------Size: Diameter-:�:--------,- �p ❑ Y, V .�, Cesspool. Distance from nearest well--------------,--Distance from foundation_-_1 ------ -� Lining;material?---------- ------------------- --- p i .De nth ;---------- ------ -`-•-- = L;quid Capacitygals. ❑ Size: Diameter---------------- -- ------ --- -�. � .r:t } ( � ,— t Distance from nearest well..................- - - ' Distance from nearest building .--_--------------------- Privy: 1 ❑ Distance to nearest lot line---.--------------------- ----------------------{ Remodeling and/or repairing (describe} = - ...w --------- g - , � ------- ------------------------------ ------------ ---•------------- f ---------------------------------------------------•----•--`---I-------..---------•------'------------------r•---- - t +C ----------------------- ------- be done I hereby certify that I have prepared this application andthat the workLocal Heallth District^ accordance with San Joaquin Counfy ordinances, St a a laws, and rules an regulations of the San q -----------------------------------------------(Owner and/or Contract (Signed) -.-- --- - ----- ----------- ------ - �� (Title)------------------------------------------ --------------- 13Y'- -----------------•------ ---- -- - --- ------- ; � (Plot plan, showing size�of lot, location of.system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ----- -------------------------------------- ---------------------- DATE - -- -- - --- --_--- APPLICATION ACCEPTED BY--------------- -- DATE----.------_ -------- =------- REVIEWED BY----------------- ---------------- --------�- --- - -- ------------------ BUILDING PERMIT ISSUED------------------ --- Alte afions and/or recommends ons: - - - -- --------------------------- x ---- .yrs - - .`' - ------- ----- _ --- ---•A----... -- ---------`!,£--`rte ----- +'fir-- _ ---------- -'-�- -- ---- - ------ --- ------------ --- - --- --- --- ----------- - ---' . --- Date-------- ------- ' , FINAL INSPECTION BY: ----- - - _ SAN JOA 1N CA EAL H DISTRI 132 Sycamore Street 814 North "C" Street est oak Street Tracy, California 130 South American t eet Lodi, California trientaca, California 1�-Stockton, Ca'fornia�� , ES-4-2M Revised 1.57 F.P.CO.