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FOR OFFICE USE: mak;:=- � y, Permit No. -/I. �� ' y.7"T 4.. . • ..... -- . APPLICATION FM SANITATION PERMIT .............................................. ........ ............................................. . Complet6 in Duplicate] pate Issued ( _. --�•Z _ _ ................... ___ ,' This Permit Expires t Year From Date Issued ,,,rJoaquinHealth District for a permit to construct and in ell the work her Ae Application is hereby mode to the Joaquin Local \ This application is made in compliance'with County Ordinance No. 549. a$'� �yo•4 J JOB ADDRESS AND L ATI`PN. e ............ ........................a----------- Phone_...��-•L��-�,3 1Q Owner s Name ._..•_' .. �7!•Q-- `-- r: c ��...rd_h -----few•.............. ...�.. .I---•------- ---.- ---------- Address I Phoned5. .----------------------- . Contractor's Name z. -t'xi`_jPr.. ----•--• -- Motel ❑ her ❑ Installation will serve: Residence Apartment House Q Commercial ❑ Trailer Court ❑ .. Number of baths .J., Lot size "f1� 0,1f 75- Number of living units: ........ Number of bedrooms -ot Water Supply: Public system El Community system El Depth tCle Water Loamable "ft• Adobe Hardpan E]Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E3 Clay ❑ y ❑FFiANA Tee ❑ No Previous Application Made: (Ifyes,date.. ._. ) No� Now Construction: Yes No [3 TYPE OF INSTALLATION AND SPECIFICATIONS: / I; (No septic tank or cesspool permitted if public �wer is available within 200 feet,) �••- Material f ld�- �'I.1................. j Septic Tank: Distance from nearest well '3 ."••Distan elfr /m} oundption-..:� Ca aci 'UuIK- Size. +7 }� / Li uid depth ' P tY t�+ i No. of compartments...._......_+---� �'-�- q ! � { � .. Distance to nearest lot line... •-•---• T• Disposal Field: Distance from nearest ti.. X�..- -Distance from foundation..- Width of trench._.._.ct .! •--•••------ Number of lines..`..__...__..•'_ _ ._. Length of each line...._.....• f•- ��//// fj Total length ...... --..__.... i Type of filter matenal__. +x'��{LDepth of filter material----- 9 \ Seepage Pit: Distance to nearest well..............._......Distance from foundation..__.............. to nearest lot fine........-.__...._ O -------------Depth_..---••---..__..__... Number of pits--l.. . .--Lining material..----.................Size: Diameter---------- ❑ -----_---•• ` Cesspool: Distance from nearest well_________________Distance from foundation.. ._--.._......... materia___.._...._---.----..........gals.als. t ❑ Size: Diameter-- ---------------- ---------------Depth------------------------- ---------------------Liquid Capacity.----- 9 1 Distance from nearest building............................•----•••--•--- Privy: Distance from nearest well...........................•----••••-•-• • ...Distance Distance to nearest lot line.............. .. 1 •- ------------- Remodeling --•---••---Remodeling and/or repairing (describe):_.. • ---••---•----•.-- _..---•--.........-• i... - --------------• --•---•---••..... - - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulation o the San Joaquin Local Health District. ......(Owner and/or Contractorl .._. Signed -•...... (Signed) Title --- ......... - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse tide). i FOR DEPAR Iv1I NT USE O.�NLLY i`- C..l--• DATE_--------- --- .-. ,. APPLICATION ACCEPTED BY------------------- . DATE._._-. ...- ----1^�.-'��7 '� '� 1 REVIEWED BY------------------------------- ..... .-- - --------------•----•---..-------.. DATE..(--:��. BUILDING PERMIT ISSUED..-•------------------•--- -•----••� - �- - - ----�_. t�G�.:�tl_•-- Alterations and/or recommendations:. .._,.... ......................... ............................ .... Date.. ��-`rAr_'�4'�'Z._.. --"----.._......._-------.-.-- FINAL INSPECTION B _ .......... . SAN JOAQUIN LOCAL HEALTH DISTRICT I124 Sycomore Street 205 West 9th Strart 130 South Amrrrican Street300 Watt Oak Street Stockton,California Lodi,California Mantua,California Tracy,California E6 9 „Evista 0-09 2M n•6l A1LAS •��e�....J� `�