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FOR OFFICE USE: J �l IQ r.., Permit No. ......... .. . ------------------------- --------- APPLICATION FOR SANITATION PERMIT ---------------------- (Complete in Duplicate) Date �ssuedT --�--. -------"- ----------------------- -- This Permit Ex fres 1 Year From Date Issued / ------- -- - ----- ----- ---- ---- ----- ----------- } r —� 0 2 Application is hereby made to the San Joaquin Local rdealth District f or a permit to construe an instal+ a work herein descr0- Thiisapplication is made in compliance with County O � -4 f 2 zz Q . G�7`a � t3 d -�_�a_ -4r /�' aP `J JOB ADDRESS AND LOCATION.__ - :/_-� " one ------------- �--- ------------'---------------------------- Owners Name--------- .. - -•-----------••---------.. � � - -------------- Address-------------- --•-�---•---- ,� ------- one--------•--••--•------------------- - ------------------------------ -- - ------ Ph Other Contractors Name--- -.-__- - , Motel ❑ ❑ � � Commercial ❑ Trailer Court ❑ Installation will serve: Residence [P'�Apartment House ❑� f 9 �f °� _ ' .�-. Number of ba hs_"--�. Lot size ---/_9 4 Number of living units: __�._ Number of bedrooms -_-"__ Private ❑ Depth to Water Table -------- ft. Water Supply: Public system �ommunity system ❑ Adobe ��, rd/pan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ --Sandy Loam ❑ Clay Loam ❑ Clay ❑FNA/ L�"1' ��O ❑ Previous Application Made: (if yes,date-------------- 1 NO ew Construction: Yes [ Bio ❑ VA: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material--S:.-L�- �C � Distance from foundation--��-� -- �o�,o Ca aeit k: Distance from nearest �+e =�Q --0----Liquid cieth_-_- ----------------- Septic- p y - No. of compartments_---__.3----------- I �l__----.Distance to nearest lot line--_ �'S-- Width of trench. -�� Disposal Id:` Distance from near st welL__- --.-_-4enance th of rom e chine anon Number of lines---"- g Total length--/-SV- Type en th -SV k Type of filter material---I + ----------- -------Depth of filter mater al__-."_ --�- g Seepage Distance to nearest well f �r -�-----Distance from foundation_--1Q-.i--.--Distance to nearest lot-lie...�-------- Linin material_- -----Size: Diameter..___:3-. -�/.-- Depth Number of pits_- --- g . 9 ` 1 Distance from nearest well--------------_Distance from foundation------------ ---------- _Linin' Capacity_ gals. (� Cesspoo$: --Depth------- --------------------- --------------------- g p y- -------- ---------- ❑ Size: Diameter.! building --------------------------- ------ - 1 ..�- - �.- PnvDistance from nearest well_--__."------------------ Distance from nearest bi ing_- v DIstance,to neo.rest-lot..ine,_-"------------ ___ --------------------------------- - -------------------------------- P Remodeling and/orerepairing (describe):------.y ---------- ° 1 -_ --------------- - 1% "ZI - --------------•----------------- ------ --------------- "'k , - --------------------------------- 1' _ _ __ __ I -�`"--- -------------=-- --- 1 I hereby certify that ! have prepared fhis„applica+ion and that the work will be clone in accordance with San Joaquin County ordinances, ate laws, and rules and regulations of the San Joaquin Local Health District. L _ [Owner and/or Contractor) oBaa (Signed) t -------- itl -�J Sy: , --- - ------- ------------------------- [T B) buildings, a+c., can be placed on reverse side). � `[Plot plan, showin a of lot, ovation of system in relation to welds, s, FOR DEPARTMENT USE ONLY r �_ DAT E------3 -- s --- v--------------------- APPLICATION ACCEPTED BAY"_.---- DATE -- '---.---- -------- REVIEWED BY------------------ -------=-------- ----- ------ ------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED----{--__'--- --------------- ------ ------------------ ------------ -------Alteration -and/or ec mmendati s: --- S F " ---- ---------- -=---------- ----------------------- -� ----------------------- ----- --------- Date--------------- - F1NAL INSPECTION BY------------------ ------ ---- -- - - ----------- -- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. 300 West Oak Street Tracy,California Lodi,California Manteca,California Stockton,California F.P.CP. - y