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FOR OFFICE USE: J LL Permit No. .,fz --------------------------------- -------- APPLICATION FOR SANITATION PERMIT -�� s (Comp lefe in DuplI icafel Date Issued _Z:,:J •-�(� ---- ------ ------------- ---- This Permit Ex :res 1 Year From Date Issued -------- ----- Application is hereby made to the San Joaquin Local Health District for a permit to construct a, ininstall the work herein describe i This application is made in compliance with County Ordinance No, 544. JOB ADDRESS AND LOCATION _" _- _ 4 ./ F PtIone ------ Owner's Name �.-_ _ n�-zn 'Y1- -------------- Address---------------------- --P_ r , - ---------------- ------- --------- Pone".._._.._.------•- .. Contractor's Nome---------r!�f! -le---------------------------- - ------- -- Motel Other ❑ Installation will serve: Residence.] lApartment House ❑ Commercial ❑ Trailer Court ❑ a �`� Number of living units: �---- Number of bedrooms �- Number of baths -�--- Lot size -----_____ -- { th to Water Table�4 a_ ft. Water Supply: Public system ❑ Community system ❑ Private,[} Dep Gravel Sandy Loam ❑ Clay Loam Clay ❑ Adobe[I Hardpan 0 Character of soil to a depth of 3 feet: Sand ❑ ❑ FHq/VA. Yes ❑ No ❑ N v Previous Application Made: (If yes,date-"-------- .: ) No ❑ New Construction: Yes ❑ No ❑ U0 TYPE OF INSTALLATION AND SPECIFICATIONS: G (No septic tank or cesspool permitted if public sewer is available within 204 feet.} Distanr�e from foundatio q p `f o. . crest lot line" -----------• Y� 5----___Li uid de th fiance to nearest p Y """ �"" Septic an Distance from nearest well .,". t No. of compartments-----�--------�---Size - --- f - -- t Distance from foundatio a_-."_----.Dis �� 1 Disposal Field: Distance from nearest well �------ Q-r N ith of trench-. ` _-- ------ I Number of lines--_.--- Length of each line-_ -/ I�ff __ - ---- ---------- " Total length 1` y- '� Type of filter material, .`------------Depth-of"filter mater�al-_--4--_ ------- 1 ' Distance from foundation_------Distance to nearest lot lin __-____-•- ��-�/ i Seepage Pit: Distance to nearest well_-_-. --- De th_--A �'--"-- • -Size: Diametl�� -- - P Number of pits-: ------- - ---Lining material. s?'✓�- I 1 Cesspool: Distance from nearest well------- Distance JL I from foundation-_------ Linuid Capacity gals. ❑ Size: Diameter.-_i----------------------- ----------Dept:-ham_-•------------------- - ----------------- a p y---------------------- .: I -- -----Distance from nearest building Privy: Distance from nearest wail-_-"--------------r ' v -"---. ❑ Distance to nearest lot line----------------- - ----------------------- - --- II ------------------------ Rodeling and/or repairing (describe):-- -------------------------------•---------------------------------- a I -------------------------------------------------------------------------------- ------------------------- ---- ---------------- -t -------------------:-- ----------------------•-------------- ------------------------- ------- -------------------------- r ----------------------- - hwill be done in accordance with San Joaquin I hereby certify that 1 have prepared this application and that te work County ordinances, State laws, and rules and Local Health District. regulations of the San Joa - --- ---- ------------- ----------------------------------(Owner and/or Contractor) f (Signed) ti -------- ► ------------------ f ---•--------------------- ------------------- -------------- (Title) stem.in-rela#:ion}oiwells,rbuildbe placced an reverse side).,T. (Plot plan-.,showing=sixe-of-to#,-locataan�oftsy t - { FOR DEPARTMENT USE ONLY IDATE ---------------- ------- --------------- APPLICATION ACCEPTED BY-.. . � ? �' = -------- --------------------------- .��' =- - DATE-------------------• -------- --------- ----------------- IREVIEWED BY--------------------------- ----------- ------------------ ------------ ----------------------------------------- ------ -------- ------ DATE---------------------------------------- ----------------- BU1LDlNGPERMIT ISSUED -------------------------------•----------------------------------- - ---- - - ------------ AI#erations and/or recommendations:----------------- _ "__"..__"--_-_."_- --------------------- ----------------------------------- I ----- ---------- -- ------------------- - .4L-------------- Date.. .. Z----f--- 7 k FINAL INSPECTION BY I i SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. I 308 West Oak Street 124 Sycamore Street 205 West 9th Street Manteca,California Tracy,California Stockton,California Lodi,California F.P.CO.