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FOR OFFICE USE: ------------------------ --_. -- APPLICATION FOR SANITATION PERMIT - Permit No. 1� (Complete in Duplicate) Date Issuedl__� This Permit Expires 1 Year From Date issued istrict for a permit to constru5t a 'install the ork erein described. Application is hereby made to the San Joaquin Local Health Dlicat This application is in compliance with County Ordinance No. 549. PP s ma JOB ADDRESS AND FCATiO ___- � �C---�-- ---1-` ' - - -- -- ------------- - ------ ---------------- --- ---- --------- -- -- - -------- Phone-------------- -------•---•---•---- Owner's Name---- --t Address_----------- ---- -------- M� -_c •--- _ __ --- --------------------------------------•--------- -•--------------•- _..-- / -- - _ Phone��_��-¢'Contractor's Nam } ! Motel Other ❑ Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: _l-__._ Number of bedrooms _ 3... Number of baths -1 -- Lot size ——---------------------- Water SuPP y• Public system ❑ Community system ❑ Private lDe th to Water Table Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Previous Application Made: {If yes,date-----------:--- ----) No ❑ New Construction: Yes El Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se is Ta fC`� Distance from nearest well-----------------Distance from foundation--------------------Material----------------------______-_.____..__--.._--_. o. of compartments--------- ------Size-------------------------- ------Liquid depth-------- ----------Capacity---------------------- .4 - Distance from foundatio � ---------Distance to nearest lot line_______._ osalVed Distance from nearest well_ ___ ___ __ __ Width of trench_�4e"-- ---- Number of lines---•-l-- - ----- --- ---Length of each line---- - -LQ-------��- /� --+, ___De th of filter material__--.. 6_------dotal length__________________ 4 Type of filter material- -- - p Seepage Pit: Distance to nearest well-------------_--------Distance from foundation------------------- Distance to nearest lot line----------- ❑ Number of pits---------------------Lining material------ -- -------------Size: Diameter.-------- ---------- - Depth-----=--------------------------. Cesspool: Distance from nearest well________________Distance from foundation---__----__--------Lino s egals. Size: Diameter------------------------------- ------Depth------------------ -- ------ -------------------- q Capacity Privy: Distance from nearest well ___------------------------------------- --__.-Distance from nearest building----------------_----------------------- . ❑ --------------------------- ------------------- Distance to nearest of ine---------------------------------- -- ---------------------------------------------- i Remodeling and/or repairing (describe)--------------- --- -- ----- - l J ------------ ------------------------ � ---------------- - --- - -- - - ication and that done Iher eby certify that �have pandaregulat ons olf the San Joaquin hLocalkHeall heDistric+� accordance with San Joaquin County ordinances, State laws+ alba caner r Contractor) d Si tee _ ' -t/d ------------- ( g ) SEPTIC YANK SERVICE - Title g)1391-5-E:-Miner-Ave--------H .6 d4 ------------------------- ------------- ---------------------------------- ---- (Plot plan, showing size of lot, oca ion of system in relation ti4buildin , etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY - DATE_14- pp-4 APPLICATION ACCEPTED BY1 �` --------------------- -- --,- '4 ------------------- REVIEWED BY----------------------------------- ------- - --- ---- --------- -------- --------- ---------------------- -----•--- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------- -----------–-------------------------------------- Alterations ---------------------------Alterations and/or recommendations:------------------.----------------------------------------- ----------------------------------------------------------------------- - ------------------------------------------------------------------ -- --- ------ ---- -------------- ------------------- f - - ---- FINAL INSPECTION BY: - /��ry�'''L.G�-��------------------ Date_./� �--�'�----- --------- ----- ----- ---------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.fiaselton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Gallfornla Lodi, California Manteca,California Tracy,California F.P.CC.