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FOR OFFICE USS: APPLICATION FOR -SANITATION PERMI Perot No. - - -- --• ��, --- -- - ----- ------- (Complete in Duplicate) Date Issued T' -- --- ----------- --------- ----- - This Permit Expires 1 Year From Date Issue - --- tion is hereby made to the San Joaquin Local HealthDistrriic for o a permit to construct and install the work herein described. Applaca ljance with County Ordinance This application is made.in comp , . r _ _ �J4NT�-�� - JOB ADDRESS AND LOCATION=-Si , Phone-------------------------------•--- g _ Owner s Name__ UJ �l' �Q s� X 1_� Address___ _- --• Phone_ --- �y .------ a ------ -- .. Motel ❑ Other ❑ Contractor's Name___ Commercial ❑ Trailer Court ❑ InstaNation will serve: Residence Apartment House ❑ --. Number of baths__.__--- Lot size -- ��'� `ef Number of living units: __ -____ Number of - Depth to Water Table _-.___ _ ft Commun'sty'system ❑ Private ❑ P § Water Supply: Public system ❑ ❑ Clay Adobe❑ Hardpan ❑ Character of soil to a depth of 3 feet-. Sand Gravel ❑ Sandy Loam ❑ Clay Loam y ❑FHA/VA: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ _ Previous Application Made: (if yes,data__._-------:------ TYPE - } NO TYPE OF INSTALLATION AND SPECIFICATION ;._ .;� (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Distance from nearest well---------------- Distance from foundation-uid de th_ Materia -__Capacity----------------------- Septic Tank: q p ❑ No. of compartments-- -------- Size � - Distance to nearest lot line--- width ine---Width of trench.__-_.-_�� - ------ Disposal Field: Distance from nearest well.- ----- Dingth from foi ndatio ft _----_-_Length of each line_. __. Total length_ Number of lines.--------I---- -----------------•-- r Depth of filter material__-- ---- i Type of filter material.__..Re�- p pistance.to Barest lot line------ d -- De th_._._ e Seepage Pit: Distance to nearest well �`` ----- Distance f m fo ndation______ ______ ___r �y Number of pits--- ---t---------_-Lining material---_I Size: Diameter--(-o-- --- p Distance from nearest well _______________DDepthce from foundation_.- - --__.-.-----Liquid Capacity-------------------- Size: ----- -----= ------- gals=I Cesspool: . ❑ Size: Diameter:._ p --------- ---- ------------- { Distance from;nearest well----------------__-------- - --- --------.Distance from nearest b-- -- -------------------------------- --------- ! Privy: ❑ Distance,to nearest lot line ---- ------------------ ---- i 2� N y� i� ' -------- �Z /f'---------------- --------- Remodeling.and/or repairing descnbe}: -f �!2-La�E-Z - ---------- - ----------------=-------------------------- -- --------------- - - --------- --- --- - == - ------------------------ --------------------------------------- -- ----------------------------------------- --------------------- _ ------- - _ --- ---- --•----- 'i ` - •----- -- 7 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and �rule�,andegulations of�the an Joaquin Local Health District. J(Owner andfor C � — (Signed)_.-- - i -- - - - ------(Tit a ------ --- ----- By:•__.__..----•--••----- ---- -"---- --- --- - --- buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in relation to wells, FOR DEPARTMENT USE ONLY � I v DATE...-----�-.---7r 47- -------------- DATE---•-------------- •-------- ----, --------------..---- ---- APPLICATION ACCEPTED BY____-- •--- l REVIEWED BY------------------------ - ---- ------------ - .. l BUILDING PERMIT ISSUED------------------ --------------------------- ------ - ------------------- Alterations and/or recommendations------ ------ ---------- ----- ---- --- --- ---- ------- --- _..Y.. ---..-----_- ----- ------------------ -------'--- ------------ - --- ------------------------------------- ----- --- -- -------- --- ------------- - . ... - -- ------------- --.------- --- Date------ ------ -------- -- -------------- FINAL INSPECTIO� • - SAN JOAQUIN LOCAL HEALTH DISTRICT 124 sycamore Street 205 We est street 300 West Oak Street ; 16o1 s.ma:elton Ave. racy,California Lodi,California Manteca,Californialifi Stockton,California E H 9 2M 1-67 vanguard Press _