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Xa t FOR OFFICE USE: (� i �j Permit No_ ______________ _ --------- ------------ 1�'APPLICATION FOR SANITATION 1�te P } �-- ----------------------------------------------------- (Complete in Du licate Date issued _____. -------------------------------- This Permit I x ices l Year From Date Issued _(Sn -O 6 on is hereby made to�the.San Joaquin Local Health District for a permit to construct and install the work herein descn ed. p,ppliceti Y This application is made in compliance; with County Ordinance No. 549. JOB ADDRESS AND LOCATIONi_( �_i_..-�f- __. �R.__�-�_: f��---•�11 .. Phone��-�- _ "Fun ------------------------ Owner s Name--.,A # '.� -C �--- 's"-F------------------------- Address--- - • 1B' -- �------- _Tn!_)- ---5 r - >� �- lid .r ------- Phone--------------- Name_.__�?ii+� '_ t� Motel Other L.4Ic Installation will serve: Residence ly Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ 0 &—y.Mp) 1041Numbe� of living units: _____.I_ Number of bedrooms -------- Number of baths -------- Lot size ___________________________ t 'i Private ❑ Depth to Water Table 3 ft. Water Supply_. Public,_system ❑ Commur i#y syste k Sand Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Character,of,sa 'to a depth of 3 feet• "Sand ❑ Gravel ❑ Y 1 -. Il 4 i '�N-w Construction•:,kYes'Q No ❑„ FHA/VA: Yes ❑ Nom, ` Previous Application Made: (If ye�ls� date__._ TYPE OF INSTALLATION AND SECIFICATIONS: (No septic tank oAesspoolti.permi#e:d if public sewer i available within 200 feet.} � t T 4104n � �' � _ I i Septic Tank: Distance from nearest well-15-01___=-__Distance from foundatiLn_u�>�Bpth__M nal Capacity,_.�s3- f� ,�'' ' __Size_-- - -- ------------- No. of compartments_ � ----- rl� ?� ci ` _-_-_ Distance from foundation._�_fa --------•-Distance to nearest lot ire_________________ Di'sp,6sal`Field: Dista nce from nee: st well Width of french___-_A4 ----------- 1C er of lines:. Length of each line-------t� ---------------Total length-------- �•------------------ -F '�► 3ll 4Numb .. T Typ of#liter aterial-` .4-AW- ------•-Depth of filter materEaL.__f_q---.------- Seepage Pit: INstan��'ce to nearest;we41---------___________-"Distance from foundation___.__.______-_____.Distance to nearest lot line__.._______.___._ � _ .. ❑ Number of pi'tts ` " ining' aterial�___---��-----------Size: Diameter -Dept #" Dis#ante framfoundation- Lining material Dista ce from nearest well - �L'i'uiil -a aci -------------__ •--•--gals. Cesspool: Ali ,-- q .,pa city, ' ---- - ------Depth ci r $ e = iamete ,t 1` p r"'k+.�--�� t��l T' Distance fromtneest well __. " - -- --- - ---------- ----Distance from n��rest building--------------;PrivDistance to neaest lot Iine -------------------------------- Cl i - r �.-s -- - ------ - ..:.. --- ------------ ----------------------------------------------- pr. -----•-----------•----------------------------- --------- or rre aiTingt{de crEbe):_ -- - ----- -- .R'emodel�ng an<a'�� p ----------�---------•--------•-- ---------------------------------- I - ----------- - .. - _ -_ ----------- 4e II f AA- ( 1-� �--------------------_- ------- --------- -----•-------------------------J I ----- ty --------------------------- - •-. done i I hereby certify that l have preparedulat ons olf +he San Joaqui hL calkHeal heDis+r ctn accordance with San Jaaguin Coun ordinances,-S"f to laws„-and,.rul$s.�and.reg AVANT-; ---- --------- - - - *, --- �(Owner and/or Con+rat+or-) _ -- --- (Signed -------•---•------ Title.---` ------ I By:.- - ----------- --�--__�w:� ,_- ::. ��:.: � --------------------......�... (Plot plan, showing size of:lot, location of system in relation to wells, il buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY - --- - --- ---------- -------------------=-------------------------------- DATE---------------2 6 APPLICATION ACCEPTED BY_--- --- 1r.------. D'ATE___-__ 7---•-------- 7 ----------------------- REVIEWED BY-------------------------- --- - ----- DATE= _• _ ------------------------- .,------� ti ar:+li wr BUILDING PERMIT ISSUED - (�� -------- ------------------ -------- ---------- - Alterations and/or ret mmendations:_ -•- --- - --'_---” ------_-l----- ----•----------------------------------------- •---- 'fI ----- ------ ------- . ------------------- -------- 1IRR ----- _- Date_-.- 4 FINAL INSPECTION B :--_ ' ------ I ' SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 Wast 9th Street 300 West Oak Street Tracy,California 130 South American street Manteca,California Stockton,California Lodi,California Ee-9 RfVIBED 8.59".C7.SM 6.60 {