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LRE USE: - _ -_.tqA-�=�---- gppLICATION FOR SANITATION PER MIT Permit No.//.. _4 DateIssued(Complete in Duplicate)+ This Permit Ex fres 1 Year From Date Issued --------------------- "" permit to construct and install the work herein describe . Application is hereby made to the Sari Joaquin Local Health District for p This application is made in compliance with County Ordinance No.1549. �[/� �}, - 1 - . ` yy , ll -- JOB ADDRESS A D OCATION%------ = --- „�,�. _.. . Phone_1:{�--� - k�,V n r------------------------------------ ----•----------•----------------•----- --^� ------------•--•-------------- Owner's Name---- � ` ; S . �--- _..__ Phone_._ . - F Address-----•------------�..�_. -�-------------•- - - '_(at;f�>�_l S-- -Z--•-----�._�_�°=- -------------- ----------•--•-•-- - Motel ❑ Other ❑ Contractor's Name-------- _ .-- Commercial ❑ Trailer Court ❑ Apartment House ❑ �- JC1 <�c� ' Installation will serve: Residence p Number of living units - - Numbe�of bedrooms,;- of baths --I____ Lot sjze ""1.- *' f�_ De th to Water Table Community system ❑ Private ❑ E p Adobe Hardpan ❑ Water Supply: Public system - 1 r Clay Loam ❑ Clay ❑ 4a1 No New Construction: Yes No ❑ FHA/VA: Yes ❑ No Character of soil to a depth of 3 feet: Sand ❑ avel ❑ Sandy Loam Y . Previous Application Made: (If yes,date_-- T• t � ) a .• TYPE OF INSTALLATION„AND SPECIFICATIOubI'c sewer-is available within 204 feet.) s ��` (No septic tank�or cesspool permitted if p ! Material_ = = -------------------•�. Di to ce'frorr+ nearest well_I?- r Distance from foundation____)- ' --- Capacity..� �-- Septic Tank: 4, ----- No_,of.compartments------��----•-�----Size_3."�"-�---K-�-- ----Liquid dept --------- -- �, R, _ , 4 ;�' _ a-_""-"-"_.Distance to nearest lot line."-•-- ------ ----------Length of each line- `S ;__._Total hlength rich.__ - t Disposal Field: Distance from nearest well�.w�------ once;from foundation-_-__. ___ of Number of lines ." I Type,_of filter�materia4___ "e__l�_.'L�`'"Dep#h of,filter material_____.__")" -- -,., ---------------- Seepage ' I Distance to nearest well---�Q-N-e-----Distance fro foundation_•__. -------------- ----- ----Lf rice toDeatrest lot ,- --- N Seepage pit: -h!�Size: Diameter__-____�� ---- - p tionDi Diameter— Linin material_ -------- Number of pits- )i I-------Lining material S.__._. Lining I Distance,from znea est;well-----------------D pante from four<da ---Li Liquid Capacity_:_------------ gals. Cesspool: q I . _ Depth I Size: Diameter__. --- -- - Distance from nearest building------------"•--------- H a ❑ Distance.fromnearest well ---- _ ' Privy: r [' rl--I-------------------------- Distance to nearest lot line_-----:---- ---- r -- ❑ "- F- "� F " •tet ----------- Rem od li and/or rep firing (describe]: `"." ----------------------- --- ------------------ ------------- 9 t ;4 - f _____________ ______________ ____________ V1 r E-e- r r I herebycertify that I have Qrepared this app lIca he San 4 that Joaqui hLo al HealtheDistrlG}n accordance with San Joaquin County ordinances, State laws; and rulesann anii d regulations o Contractorl r-•--- ran r nn # t n ned)-------•---� -- ----� �# �� ' � ------ ----� Title)---------- -- ---- - - ---'------- ------ • ---------------- (Sigy {2, -� e Plot plan, showing size of lot,,loation of `stem to relation to wells, buildings, etc., can be placed an reverse side). I ) FOR DEPARTMENT USE ONLY l ------------------- ' _ DATE---- ' "J ----------- -----------------------APPLICATION ACCEPTED BY_---_ ---.-- t DATE----------------------- -------------------- REVIEWED BY_ r--- -------------------- - -------- -------•--- DATE , -- -------- ---------- ----------;,•....mow. .s. j ��5 ` BUILDING PERMIT ISSUED--------------------------- ------•--- Z ._. - i .4. - - �.' ,, Alterations and/or recommendations _.-" ZS ----------------------------------------------------------- ------------------ f - -•------ ------- - ------- -------------- ,. ------------------------t r ----------------------------------------------------------I----------------------- s- ------------- ----- - I ------ -------- ------------ ; ' ---- --' ------------------------ ._. __.-_- _ i --r ; - �... .�,... IDate--- - . - - �- a FINAL INSPECTION BY:_-_-_-_ ---- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 300 West Oak Street Tracy,California 1601 E.Haselton Am Lodi,California Manteca,California Stockton,California ES 9 REWSEo 8-59 3M 3-'63 F.P"CU.