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Permit No. . -• --- Y 1 -APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ---l-i=--F w, T permit to construct and install the work Wow described. made tori the San Joaquin i h CLoc;40 deinatncee No. 549r a p ' Application is hereby ------------------ -------• Or This ap lieation is made in eo� r _ �M/rf�� t �� _ - ---------- Phone------------------------- - JOB ADDRESS AND LOQ AT10N_. ------------------- ----- - �.y— - r -----� r�►� Owner's Name C�l1fL' i 4 '�7 .�[T C/�- T�, I� P11Dne. Address---------------------- -- _ �=�--�--�� Motel ❑ other �,- Co6fractor's Name________________ •- Commercial ❑ Trailer Court ❑ Apart House ❑ - Installation will serve: ,Residence ❑ p Number of baths ------— Lot size --.------ ,- -------•--•------ Number of living units: __. -" Number'of bedrooms _- Depth to Water Table -. ft. stem ❑ Community system ❑ Privateg. p Adobe❑ Hardpan ❑ Water Supply: Public system Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ f No FHANA: Yes ❑ No Character of soil to a depth of 3 feet:: Sand ❑ Application Made: Yes ❑ No New Construction: Yes ❑ t Previous App • `�� '` � TIONS: t l } TYPE OF INSTALLATION AND SPECfeet.) (No septic tank or,cesspool permitted if public sewer is available within 200 Material_----------------------------�j----- . 1 �a Ca ac+ty.-.O p Distance from nearest we ---- "_------Distance frsm four da--on__- - - p Septic Tank: .Size-- Liquid depth------ n -- No. of compartments------- N Distance to Barest lo�ttli�ner Length of each line------.S"�--.-. 'Width of trench-----!/#'� (� Distance from foundation_ ". Dispos Field: Distance from nearest wel4._._r_-- �� - -----_ Number of lines_____._ ""-- _Total length-------.�--- - Type of filter material----- vG, -- ---Depth of filter material------ ti Barest well----------------- Distance from foundatio•n___________-______:Distance to nearest lot line______________:__I Distance ton --------------------Depth---------------- ----- Vj Seepage Pit: Size: Diameter--- its ------------------ Lining material ---------------- ----I , ❑ Number of p gaC Distance from nearest well--------- -- 3;Distance from foundation_ --- - -•-Liquid Capacity--------- Cesspool. j ❑ Size: Diameter = �D p - Distance from nearest building _ i Distance from near`est.well------------- ---------- ---------------- = :. Privy: •" - . . __+�--:_-"-: --�-•---- ._ -_M.--= ❑ � Distance to nearest lot line:^""'""'_-- -- � ----•--__•• ---------- Remodeling and/or repairing (describe):----------------------------------------------------•---------- - ------------------ --------------------- I --------------------------- -------------=------------ } . -:; -"----"----""----------------------------- -1 have--_-repared this application and that h work ocal Health be-cDistlone accordance wi#h San Joaquin County I hereby certify thatp ations of the S'an Joaquin and les and g ordinances, State I _ ------------------------(Owner ane/or Contractor} [Title}-------(-a(Signed) -- buildings, etc., can be placed on reverse side). By=----------------------------- I y [Plot plan, showing size o lot, ocation of s stem in la#ion to we s, T USE ONLY FOR DEPARTMEN ----------------------- DATE--------------------- ---------- ---�- - -------- ------------------ ------- DATE---- �� --------- APPLICATION ACCEPTED BY-------•----"}-------n- - - -------------------------- REVIEWED BY------------- _ = ' � .._ ---- - .DATE------�----'---- ------------------------ ----------------------------- BUILDING PERMIT ISSUED--------------------------------= ---- --- - --- •------------ ------ ------------------------------- and/or recommendations:____--E------------------- -------------- ---- --------------------------- ------------- --------------------------------------------" -_- ---'----_--` ---�-'.`-�--'----- __ . Date_.------ FINAL INSPECTION-BY:-_ ---r---= -`=---71 /,,- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 Korth "C" Street 132 Sycamore Street Tracy, California 300 Wast Oak Street Manteca, California 130 South American Strea# Lodi, California Stockton, California E5 9-2M , Revised 1.57 FY-CO-