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r _ V Permit No. N APPLICATION FOR SANITATION PERMIT 7 (Complete in Duplicate) Date Issued -� rid install the work herein described. Application is hereby mDistrict for a permit to construct a ade to the San Joaquin Local Health his application is made in compliance with County Ordinance No. 549. ' 6t JOB ADDRESS AND LOCATION---_- --- - Phone � - `- i�f. ----------------------------------------------------- Owner's Name------- - ------•- ---- Jd tet. -- ---------------------- ------ -•--------------•------ -- Address-------------------- ---- -•------------••---- - ---- ---------------------- Phone.- •- -----�--`---------------- Contractor`s Name__ .-- •-- " Motel�,[� Other ❑ ------ Commercial ❑ Trailer Court ❑ Installation will serve: Residence [2' Apartment House ❑ "/ ✓"ri " Number of living units: __ _-- Number of bedrooms -- Number of baths ---i---- Lot size ____ ------ ___ _ __ "-- Private Depth to Water Table �s ft Water Supply: Public system ❑ Community system ❑ ❑ Clay Loam ❑ Clay ❑ Adobe�Mardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Y FHA/VA. Yes [I No E s Application Made: Yes f_1 No New Construction: Yes Previous No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ----------- Material---------- ---------------------------- Se t'sc T : Distance from nearest wel4-----------------Distance from foundation-uid depth_:-""-------- - Capacity----.------.----------- No. of compartments------------------------ Size---------------• a��aDistance to nearest lot line-___----ill--sem Disposal F" Id: Distance from nearest well.___- ' Distance from foundation-,�----- -- "�� Width of trench------ �' Length of each line------ --= ---- Number of lines--:---- = g Total length_._.___ -�� . Type of filter materia �� ------Depth of filter material___��- ---- s Il�rta� TDistance to nearest lot line-- Dist n( Distance to nearest well - _ Distance from foundation___. . Depth__ - ----- Number of pits-._._---------------Lining material_- - --- ----Size: Diam ter__ ing Distance from nearest well_________________Distance from foundation.-------- Liquid Capacity gals. (/1t Cesspool q p Y ❑ Size: Diameter----------------------- ------ ------ Depth---------------------------------------------------- 0 ---------- ----- ------ ------------------ ---- rivy: Distance from nearest well_--.___------------------------------------- - Distance from nearest building --- Cl Distance to nearest lot line----------------- --- `` ` "� n Remodeling and/or repairing (describe):---_C6 '- ----------------------------- °----------"__-_"V --------------------------------------- ------------------------------------------I------------ that the work will be done in accordance with I hereby certify that I have prepared u�aiFans lli the San JoaquiLocal Heaf hdistrSan Joaquin County ordinances --S-ta�te laws, and rules and reg Owner and/or Contractor) r -------------------- $i nedt� a ( 9 )- ---------------------(Title)---- t -� ------- - By:.----------- (Plot plan, showing siie f lot, location of system in relation to wells, buildings, etc., can be placed on rev ers side). � ,i FOR DEPARTMENT USE ONLY DATE------- . APPLICATION ACCEPTED BY -•----- .. DATE REVIEWED BY-------------------------------------- --- o------- _ - DAA ` BUILDING PERMIT ISSlj1 D. w ,/� = ------ _ _ _ � — s r.c.. _-.- . " p. yam` -:�____•_ ___•`_�__-_ - __ Alterations and or recommendations: - -..-. - -------------------------------------------- •---- - -- - v :: - . - ---- ---- � ------ --- -- t • ----- ------ _ �- ------- -�. - -_----- - -I- - ----------------------------------------------- - - /------ ' FINAL INSPECTION BY:___- --,.- -�-- - -- --- f SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 300 West Oak Street Tracy, California South American Street Lodi, California Manteca, California Stockton, California ES-9-2 M , Revrseo 1.57 FY-CO.