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FOR OFFICE USE: , ............................. "- Permit No.�_� 1�.._... APPLICATION FOS SANITATION PERMIT ---------------------------------------------- (Complete_ in Duplicated Date Issued ---------------------- This Permit Ex ires 1 Year From Date Issued - ----------------------------- -------------------------- Application is hereby made to the San Joaquin Local Health Dice strait f o a Permit to construct and install the work herein described. This application is made in compliance with County JOB ADDRESS AND LOCATION r '-------- 1 0 ...__ / Phone._ �afL Owner's Name-------------=- ------ .. ----------------•-----•------ t, o. -- = Address-----•----------- � Phone.. ----------------------------------------- Other Contractor`s Name________________________ Motel ❑ Apartment House ❑ •� Commercial ❑ Trailer Court ��,r �. Installation will serve: Resident Ap - /i___------- --- -----_____._.-_-- Number of living units: --/---- Number of bedrooms _�.- Nurriber of baths ___ _.__ Lot size De th to Water Table -�- ft. Private ❑�•_. P Water Supply: Public system �' Community system ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Construction:lYesm A Nolay❑❑FHA/VA:�s ❑ No i New Previous Application Made: Ilf yes,date---------------- -1 No V TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p I '� .__Distance from foundation_____---1_Q-____.Materiah-__!l_ - --w-O-c°�-- Septic Tank: Distance from nearest well---- - -- Liquid depth_..__-✓ c_. ---_-----Capacity------ !!2d �L No. of compartments_..__---c-...__-----.--Size-__ __ )Q Distance to nearest lot line-/'----------- CDisposal Field: Distance from nearest well .._�--, -nenath ofnce reach line om foundation------ --- --------Width of trench------� ---------------- Number of lines----------- +�V th'of filter material-----� __11----------•Total length--------- �---------------------- Type --------- --------�---- Type of filter material.__�'.__1eI_c_k,.-Dep $. 1G d-__.Dista ce to nearest lot line__.-�----•---i De th-----114etA Seepage Pit: Distance to nearest well __.._-_Distance from, foundation_____ Number of pits.__.,/...............Lining material_S'- ------Size: Diameter_..__ _. _ _ . - P Qistance from nearest welL----------------Distance from foundation--..___---------_.Lining Material---------------------•------------ ----------Liquid Capacity-__ ------ ------gals. Cesspool: :De th--�------------------------- - P tY ❑ Size: Diameter. P - Distance from nearest building------------------------------------------ Privy: ----.------------ ------- --- ---------- Privy: Distance from nearest well--- ----------------------- ----- --- -------------------- -------------- El Distance to nearest lot line________.. P - __________________________________- I Remodeling and/or repairing (describe):_._.__ -.-- , ------------------------------- ---------------------------------- ----------- ------ -------- - - I ----- ------------------------- ------------- --------------------------------------------------------------------------------------------------------------- ----------- ---------•--------------------- ----------------------------------------------- hereby certify that I have preparedThis a olf the Saand that n Joaqui hLocal kHeal heDistrict. accordance with San Joaquin County ordinances, to laws, and rules and 11" w -------------------- -- and/o� 10 [Signed) --------- -- ------ - �----F. ---=-----------------=----a �'�, t f s � -- ------------ ----- -- Tit e. --------- By:-------------------- [Plot plan showing size of lot, location of system in relation to wells, buildings, etc., can be placed�on,reverse side). 1. F- FOR DEPARTMENT USE ONLY "'""' --------------- ------------------------ ----------- .'., DATE r- tr.. t DATE------- ---------------•--- •----------------------------- ------------- APPLICATION --•-._ 'DATE-------- `--- -------------- --- - -- REV REVIEWED BY ACCEPTEQ BY- -__A------ L ------------ - ------------------------ � - ------------------------�-----q----------- ;---- p BUILDING PERMIT ISSUED--------- 'ct r,.--- --- C-';,e_�/-----_.� _. ------- Alterations an /or recommendations:---- ---- -- _ ------------------------------------ .. ----------------- ✓/1�1•` ` -.ter-- �--- �'� - �-°-------- t i - - .. L 1 -------- ------ ---- ------- ---------------- -------------------- ----- ------ ------ ----------- S µ pate__ f ------------------------- � "FINAL INSPECTION"BY:"::��--�'"-'-`�- . SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. 300 West Oak street Tracy,California Lodi,California Manteca,California I Stockton,California + F.P.C 0.