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} FOR OFFIC USE �� •- ---�-- - -`:�-- Permit No. -[�; APPLICATION FOR SANITATION PERMIT ---------------------------------II---- (Complete in Duplicate) Date Issued .----/?/- _/ ------------------------------------------ 4. - This Permit Expires 1 Year From Date Issued Application is hereby made.�07 to the San Joaquin Local Health District for a permit to construct and install the work h� in3 described. This appiication.is made in com fiance with County Ordinance No. 549. (0 3 — JOB ADDRESS AND LOCATION ---_ - n'l EAU _ Owner's Name .......... --- -- - -------•---• `--- -� ---- ---------- ------ --- ••-•-------------------------------- . Phone. Address...-----• � •---•------- •-•---------------•--------•----•-•--------•------------•------------------------------------ Contractor's Name --._tea• l Phone.. - - Installation will serve: Resih j] Trailer Court ❑ Motel ❑ Other Number of living units: __--.--- umber of bedrooms__--. Number of 'baths i._-_-.__ Lot size ....___---__________________________________________ dance Apartment House ommercia. I. i Water Supply: Public syste m [Community system ❑ Private ❑ Depth to Water Table -------- f#. Character of soil to a depth of 3 feet: Sand E]Gravel ❑ Sandy Loam ❑ Clay Loam [3Clay E] Adobe [--H ardpan ❑ l� Previous Application Made: (If yes,date____________________) No New Construction: Yes �No ❑ FNA/VA: Yes ❑ No [�—� TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cess ooI permitted if public sewer is available within 200 feet.) ( P P P P --- � � � 'I 1 �.a}ion_1l1-----•--- .Material Gr_------------------ Septic�i Tank: Not n Distance compartments-----.- well____ Distance ,f om found I _ Size q P 4------ -------- ZI Capacity Up�./ p _- --- -- Li uid depth _ _ i ld: Distance from nearest well.,-hu�--Distance from f u dation__.2o_`....___-Distance to nearest lot line___-._% Disposal F e Number of lines ------- ------ Mk �_____-Depth of filter material- , =':__---_.-Total length________.3 ..`---------------•-- --I--- __- �Distance to nearest lot line _` 'r. See a e Pit: ee to nearest wstance from unaton_ _....___. Number of its__ewLining mater-al____~.Size: Diameter_' ....... Depth _--._ ______.__•._=_ ia CessPool: ance from earest well ----------------- Distance -from foudaon-.--.__-_-_-_-----.Lining mater l.___-_______--___-_.___:_____-._--__ $izeiiameer--------- - f _-._Liquid Capacity --------------gals. ❑---------------- -----Dept-------- Privy: Distance from neaest well-_________________________________________�-Distancebuilding [/s.f from nearest building____-------______--_______._---.___--_._. ❑ Distance to nearest lot line-_--==------------------------------- ----- `� > r C Remodeling and/or repai ring (descnbe•--_._.C� 2 ---•---... IM s------------------------ ------------------- -----------------------------------------------11---•--------------------------------------------------------- -----------------t---•----------------------------------------------------------- ------ i� '1 - ------ --- -- -- --- ----------------- I hereby certify that'l have preps c t is application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r dul tions /of the San Joaquin LocalHealth District. (Signed)_ -------------- --_.(Owner and/or Contractor) ------•--------- ---- --------------------(Title)----- ----------------------------- -------------- By: -------------------------- - (Plot plan, showing size off I , lo c of ystem in relation to wells, buildings, etc., can be placed on reverse side). i�. I< _ ENS USE.;'ONLY ;I. APPLICATION ACCEPTED BY----------- --------------------------------------------------------- DATE --- 5r .. --�-------------------------- REVIEWED BY --------------- ------------ -- DATE --------------------•--------------------------------------- BUILDINGPERMIT ISSUED -------_------------- ---------------------------------------—-•---------------- DATE = Alt�g rations and/or recommendations:_____!--__1___...____.-�� . I ",' ` ~ - A-"_____...Jw, .------ ".K1.1L--- - �-----------------------•------ I�. -------------------------- ---- --------•--------•--------------------------------------------------------- ------------------------- ----------------------------- -- -- --------------------------- ----------- - FINAL INSPECTION Y: 101,_, Date--- .- t_3_-. ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton, California Lodi, California Manteca, California Tracy, California -ES-9 REVISED 6.59 F.F.CO. 3M 6.6a� -