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� y�� I S 1" 1 Permit No. io�� ___ --�• DI� APPLICATION FOR SANITATION PERMIT 3 (Complete in Duplicate) Date Issued I �•- Application is hereby made to the San Joaquin uin Local Health DlNoG for a permit to construct and install the work herein described. This application is made in'`I`compiiance withY 9. 4 ------ - ----------- - -------------------- ------------------ C' I'O N..JOB ADDRESS AND LO - zone------------------- . --- - ------- ----- Owner's Name------ Y ' _ ----------------------- Address --------Address._-___-_. II -- Phone----------•------------- _ ------ - - - -------- ----------------------------------•------------ Contractor's Name----"---•--= _- - - Motel ❑ Other ❑ ill' Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court r 1� ` _y Number of baths __/__ Lot size _ ----• - -1 -------------------------- Number of living units: _f---- Number of bedrooms _ Water Supply; Public s ll Community system ❑ Private ❑ Depth to Water Table Tt• pPy' y11 Clay Loam Clay Adobe ardpan ❑ ❑ Y ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y FNA/VA: Yes [ o [IPrevious Application Made: Yes El No JR' New Construction: Yes �No F1 TYPE OFINSTALLATION AND SPECIFICATIONS: cesspool permitted if public sewer is available within 200 feet.) ( p l ' Septic Tank: Dista�ce from nearest well �-- Distances/from foundation---- "___-- Material--- Cae ��, ®�' No. of compartments_.-- Size--o _- -`� _-_.Liquid depth--.- ---------- Y � ------ -��---_"-,-_.Distance to nearest lot line__t�_�._-. Disposal Field: Distalce from nearest well ---- -----.Distance from foundation_ Width of trench------- :-r------------•--- Number of lines-----/--------- ------------- ength of each line------� ------� r y De th of filter material_- --� .___ _----Total length-" --e��---------- Typel�iof filter material-� " --- - p D Distance to nearest lot line Pit: Distance to nearest well-.-------------Distance from fours i ion_`' m •-•-��--� • � ae: Diameter-- -------------------Depth--.'.��.�__----- --•-----•---- ®/ Number of pits-----f------=------Lining material'—Z 91 Cesspool: Distance from nearest well------_---------Distance from foundation-- dining material----_ als. Depth ------- ----------Liquid Capacity--------- g ❑ Size.- Diameter------------------------ --- p Distance from nearest well---1,"------------------------ �� -Distance from nearest building-----"--------------------------------- Privy: -' ------- ❑ --------=------------------- - - - ----- - Distance to nearest lot line._---__.-_----_._-: --------------------------------- �1 Remodeling and/or repl�iring (describe):--"--_. _ -- ----------- — ------------------------------- ------------------- ----------------------- --------------------------------------- = -- - --- --------------- ------------------------------------------ yaprepared ths application and that the work will-be done in accordance with San Joaquin County I hereby certify that I have cal Health District. ordinances, State laws,'Fand rules and re ulatlons of the San Joaquin Lo1 ( or Contract ---------------------------- (Signed')-. ----(Titl --- --� - --------- By:----------------=---- ---- --- --------=--------------• e} � (Plot plan, showing srzelof , location of system in relation to wells, buildings, etc.,`can be placed on reve a side].. ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- -------- -------------------------=----------- --— ------ --------- -- - ------:--------------------------- - ----------------------- =--- -- --- -- ----- DATE--------- REVIEWED BY- - DATE---------- ----0()'----------- --------------------- BUILDING PERMIT ISSUED---------------------------------- =-•----_--- Alterations and/or recommendations----------- --- ----- ------------------------------------•• V ---------------- ----- ----------- --- -------------------------------------- r-----------------•- II'-----------•r---- -----•----- _ -------------------------------------- ---------- - -------- ----------------- ---- - -- ----- FINAL INSPECTION ------------------------ SAN J -- ----------------=---------------- --- Date--...-.-1--2-- ----------- ----------- BY - --- -------------------- SAN JOAQUIN LO AL HEALTH DISTRICT 300 West Oak Street �432.Sycamore,Strest Si4 North "G" Strait ; 130 South American: Street # ,Tree California Stockton, California Lodi, California 'i� Manteca, California Y. ES•-9-2M , Revised 1.57 F-P.CO_ Il