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y---------------------------� APPLICATION FOR SANITATION PERMIT rermIT 1110• ._[/d AD (Complete in Duplicate) Date Issued ----- -1 - --------- i This Permit Ex ires 1 Year From Date issued i! �. - San Joaquin Local Healfh District for a permit to construct'and install the wor Application is hereby made to the k herein describe \ This application is made in compliance with County Ordinance No. 549. E -----------•---------- JOB ADDRESS AND CATION_-- -- Phone----------------------------------- ---------------------- ---------------------- --------- Owner's -f�= Owner s Name - r -------•--•-------- = --•------------------'---------------- Address--- -- - • --------- -- ----------- �.' one -----•------•--•----•---• ---- ----------- Contractor's Name------________ _ Motel ❑ OtherEl Installation will serve: Residence ..Ap�tment House [ICommercial ❑ Trailer Court ❑ Number of living units: -�___- Number,af bedrooms - _ Number of baths _�--- Lot siie _ ,`/ - --------------- ---------- `' / De th to Water Table Water Supply: Publicsystem'�ommun+y system ❑ Private ❑ P PPY� �f r, Clay Loam ❑ Glay�❑ Adobe �rdpan ❑ �. y Character-of soil to a depth of 3 feet: .-Sand'-❑ Gravel ❑ Sandy Loam ❑ y Previous Application Made: (if yes,date f#01- :- -------- ----;- I No L� New Construction: Yes ❑ No FHA/VA: Yes ❑ No Er 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool ermined if public sewer is available within 200 feet.] /f f I P p, ;- ; Mata --------- ------ ��----- -- l Septic Tank: Distance from nearest'well-----------------Dista�nce�f�� foundation_ ` I ��/ ---Capacity..-`1 ��- -----Size G'1 L` Liquid depth_. � _ No. of compartments-.-- - -.----- �} Distance to nearest lot line ___..-------- DC .- Disposal Field: Distance fromfRearest well.__.- -----.-Distance from foundation - - Width of trench__.""------- j ' Len th of each line--_.__- Number of lines 1 -- g - ' f Q Total length---- Type of filter materia _;"Depth of filter mat,-I , -./- -- = ? ._D'sta/{n/ce to nearest lot I fe"� ---•---• i `Q ._. Seepage Pit: Distance to nearer`f II-------7 Distance�m,�fojnd� �n piameter'_ -� Depthp -- " E Number of pits:'-A, -------------Lining material-. - ��-/ %`.. _ .---- Cesspool: Distance from nearest well-----------------Distance from found;tion__._..__--_-- Lilqui Capacity.._.._." _____._" _______._gals, S Depth -----' ----- i ❑ Size: Diameter----- ---------------- -_: p ,fy "- �� . ._ . k 'i-Distance from nearest building f Privy: Distance from nearest'well---------------------- i -------------- --------- �__.- ❑ Distance to nearest lot lire---------------------- ----- . ----- Remodeli}g and/or repairing (describe):__ - "---------------------- .... Z-. - ------- --------------- - F ---------------- ------- --- �. ---- -- ---- ---f--`-'-- ------------ ` Health Dion - - cor e ,1 Local H ------------------------ I hereby certify�fk+at f liave`,p epa`red'-this application and that the work will be•don Cir► accordance with San Joaquin County ordinances, State laws and rules and regtila 'ons of the San Joaquin 7 FI w Contractor] --------- ---------1---- Si ned .... y� By:-------------------------------------------------------r--------- --'�--------- -(Titl -- { e _ k Plot Ian, showing size of lot, location of systerri`in"rel- n to-we11s;builifings;etc.�ari-be placed on reverse side]. ) 2 FOR DEPARTMENT USE ONLY t i --------- - ------ ------------------------------------------------ `DATE.---------------- /,-�'`"---------- - APPLICATION ACCEPTED BY- '"�"-- - '- -- ---- ----- REVIEWEDBY---------------------------------- ---------------------------------- ----------------------------------------- DATE--------------------------------------- --------------------- ----- -------- ------------------------------------------ ----------BUILDING PERMIT ISSUED------------------ __-- ,. Alterations nd/or recornmen� o . . /�. --- -------- ---------- - - ----- . -- .. -- ------------ -- '9'�` -dot.- ---- - i • Date--.-----'�` --------------- t FINAL INSPECTION BY------- ------------------ ------- SAN JOAQUIN LOCAL,-,HEALTH DISTRICT; .� " 205 West 9th Street —a �� 124 Sycamore 5treet'� 1601 E.Hasellon Ave. 300 West Oak Street ti � y . Lodi,California Manteca,California Tracy,California Stockton,California x