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OFFICE USE: li Ilk / F R O L- O Permit r� APPLICATION FOR.SANITATION PERMIT 3 �/ r = �/ - __ S`-�"- -- -�^- _ [Complata.m"Auplicate} p�'te Issued --�-�`�• 1�--�- - --------- ------ ------------- --------- . This Permit Expires 1 Year From Date Issued A lication is herebymade to the San Joaquin Local Health District for a permit to construct and install th work herein described. pp This application is made in complianct3 with-County Ordinance NoE� 549. ------------------------- 11 I I Q-�—'------ -�'- =-----------•--------- ---••--------•----- JOB ADDRESS AND LOCATION--•-____-- -_..Z-: `=__ ff h -- - Owner's Name `S�-?s�__✓__ i '1 �4 . -•'---- --------••---•--- ---• ------------•----•- Address_... y !� ' --- 1 ' -------------- ------------ Contractor's _ ...1_._ __,. phone Name----------- --•- -- -Motel Other ❑J. p Installation will serve: :Residence ®`Apartment House ❑ Commercial -❑ Trailer Courts❑ '- f❑� Number of living uriits: _-_�_-_ Number of bedrooms _,f--- Number of baths _.I__. Lot size II: E Water Supply:. Public#systern RCommuriity system ❑ Private ❑ Depth to Water Table _._.___ f9. !� Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Lgani ❑ Clay ❑ ! Q� p I! r FHA/VA: Yes ❑ No � j Previous Application Made: (If yes,date-------------•---- _) No [�` ?New Construction: Yes ❑ No [�^' TYPE OF INSTALLATION AND SPECIFICATIONS: ' [No septic tank"or-;cesspool-perrhitted'if"public sewer is available-within 200 feet:)" Material ------------------------_______________________ �S�eytic , Distance from nearest well-- ----- -------Distance from foundation--_--__.-___--- --.Noy: of compartments------ --------Size--------r----------- -----------Liquid depth------------=....-----"^•Capacity_. l y/-�•_-____..----Distance to nearest lot line___ _. l Disposal Field: DisfanY a from nearest well from foundation--t-4 c W,id#h of`,trench._--L�-j----- -------- Number of lines------_--I------------------------Length of each line_t1:4a(. .------=-— r � �. �r � _.S_.___De th.of filter material_--�-j' ----• -Total.length- ' F- _ ------- [ Type.of filter matenal___r _ - P s d_. line----;P- 9 { QU___k_--_.Distance to nearest lot __..__-.._ Seepage Pit: �Di stani a to nearest. - -----Distance from foundation___ , i p II. Number of ------ --------------Lining material_ /{-� -----Size: Diameter-- -�i-_..De th----Z-3- ------- P ► Cesspool: Distance from-nearest weil-----------------Distanc.� from`foundation..-____.___---=_---"Lining materia4____._____._.---.-------------- a ----- - -- -------- I----Liquid Capacity------------ gals. ❑ ize: lame er•---------------------------_ --Depth ..----- r + s i----- __-- ...Distance from nearest building------------------------------- i Distarice-fr,m_nearest well --------------=---- �[ ` ------ Privy- -_--- ❑ ---------- - - ----- Distance to nearest lot line----------------- ,I t ' ..... f -------------- 00 Remodeling and/or repairing [describe]:__.___.- �� - � ------------------•---- ------------�-- ------'--- -------`-------------- II t + :Es ------------------- __________________________________________________________ ___________________________________________________ -------_-. . ____.._.___ _ __ __---- --------- _ -_-_-.-----r._---__--_:-;-_____:--_______________:___ ---7-7 _--------_------_.._�____ I hereby certify that I have prepared this application and +fiat the work will be done in accordance with San Joaquin County ordinances, State laws; nd rules anjr-e ulations of the n "aquin Local Health District. I Owner and/or Contractor] ! i --------------------------------------------------- (Signed) fr+ /, ------------ --- ----------- - By:-------- ---- ------ i (Plot plan, showing size of lot,llocation of system.in relation to!wells, buildings, etc., can Iia placed on reverse side). i FOR DEPARTMENT USE:ONLY ----------------- "' DATE :;� y - DATE _ `= --r------------------------ APPLICATION ACCEPTED BY-------- --�- R EV I EW ED'BY-------- --- ------------ ---- ---- --------- -=- "' DATE-------`- -- ------------- ----- "' ING PERMIT ISSUED-------==-- -yis- --- = ------------------------ o = -------- i Alterak , r " y .. BUILD " x� tions and/or recommendations:__.. :.;::: ----------- ------------- ----•--------•-- -----------I------------------- --------- --------- ------------------- ------------------ = _ I -------------------------------- I - ;-- ---- I - --------- - --------------- _ - - - ; ,.� ------- - ------- ------ -, - --------------- - !1` { �"� -------•---------------- •-----� =•-------------- ------ ------------------- = '1 ' -------=-- - - t...._-- - ---• -- ---------- II ?t y. 4 # - Date G - --- - t FINAL INSPECTION BY:_._. �C/----=•- ------ ----- -, „ ' I 1 t SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 9th Street 300 West Oak Street 124 sycamore Street 1401 E. lAve. - Tracy,California Stockton,n,CaCalifif ornia Lodi,California Manteca,California ES 9 REVIS f=D 6.563 "--Co- o. II . II