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FOR OFFICE. USE: E i _ T 3_ ------ ------- -------- - - Permit No. .�----•------•- ' ----------------- "------- APPLICATION FOR SANITATION PERMIT ! -- ------ ------- --------- --------- --------- - {Complete in Duplicate) _ Date Issued ------------_.--- This Permit Expires 1 Year From Date Issued Application is hereby made4c, the San Joaquin Local Health District for-a permit-to construct and install the work herein described. N This application is..made-in compliinee..with County Ordinance No. 549.' ZSR ~2�0�-3 �/N /,.) JOS ADDRESS AND LOCATIOI ?Nt------OF-.------`- `- ._5. � -5------ �RA-R-D = S3CtIP1Y!-+ +_V. _� ------------------ owner's ---------------- --- Phone Owner's Name-----------__-- p QQ S7 = P°n�4 -------------- --------------------------------------------------- Address-------------------C]- --- •. &W----•------- ---F ------•---... --- Phone------------------------ Contractor's Name-------- ---------------------------------------------------- Motel Other ❑ Apartment House ❑ Commercial ❑ Trailer 'e"t ❑ Installation will serve: Residence ❑ p . � �-RSA-��--------------:------ Number of living units: - Number of bedrooms _�---- Number of baths -_/--- Lot size --_ - --- -- -- I Private De th to Water Table /_3 ft. Water Supply: Public system ❑' Community system ❑ y ❑ y Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ i Saysdy Loam 3 Cha Loam Clay ❑ ❑ Previous Application Made: [If yes,date---------------- ---1 No New Construction: Yes [d ❑ FHA/VA. Yes ❑ Na'�� TYPE OF INSTALLATION AND SPECIFICATIONS: ""'^`[No septic tank or°ce§spool-Per mitted-if-public-sewer is'available within 200 feet.). Y ► Septic Tank: Distance from nearest welL,. 1 - -Distance from foundation----I _.-----.Maters 4.- N -_-- T-_-.-.------. � `- -Size 7xi- X, _-Liquid depth----1-1 Capauty O------ No. of compartments- �. p a ""~ Disposal Field: Distance from nearest w ' s ell---,j(�--___Distance from foundation--- Distance to nearest lot line----- --_: tf 1 Number of lines--- Lergth'of; each line---------- - -----------Width of trench..---- --•---y---- I a 1 LCJ TYPe,°f filter materlal-__.-�QiDe fh offilter material----.f _-.--------Total length-------------�� ------- = - � P Distance to nearest lot line--.-__._'..-.... Seepage Pit: Distance to nearest well from foundation__--_-_--------._-_ y Number of pits--- ------ Lining material�------ -----------Size: Diameter--------- ------- ---Depth } I� Cesspool: Distance f,om nearest weld--_____--_ ':Distance from foundation__.. xLining material--------------------_------ -------- --------------- q Size: Dia peter-------s "----- - ----Depth---- ------------------------------ ------------ Liquid Capacity - '= gals. ❑ � .gym Privy: I Distance from newest`'wel ------------------------------- from nearest building_..-.-.------.-------------------------- Distance to nearest lot line _.-___------ 4 -------------- = --: N. Remodeling and or repairing (describe)---------------_------ ----------.-- ----- ' ------------------------ m } ----------- ------------------------------------- -------- --------------------------------------------------- ---- -- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, S to laws, d rules and re:144_1 if the San Joaquin Local Health District. I ------- ------------(Owner and/or Contractor) (Signed) -.��. --- -------------- ----- :;. _ �— - `--- = -: ��-- BY (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed'on reverse side). FOR DEPARTMENT USE ONLY ,. APPLICATION ACCEPTED BY----._-7T .-01---------------------- �'DATE-------��-25..----6�-------r ----- DATE---------•---------------------------------------- REVIEWED8Y - DATE--------------- ----------------------------------------- BUILDING ----- - - - BUILDING PERMIT ISSUED------------- ------------------------------------------------------------------ - -- - - -- - - - -------------- Alterations and/or recommendations:.------------ --- ------------------------------ -----=-=------=----- - ----------------- --- -- _;_ Date....------- r r fc+ S . FINAL iNSP SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Lodi,California "l ` 4"Manteca,California' Tracy,California Stoaklon,California , F.P.dd- 3