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0, APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. }+ � 8017 Lower Sacramento Road ----- ----- ---------- JOB ADDRESS AND LOCATION------------- __ _ - - - Yr3t � _;_AM3 t-°n--------------- ----- Phone ---------------------- --------- AddressSof e_-a s above -•----•-------------- -----------------------------------------------------------------------------------------------------------•---- - H06-960? Pa -1: M & ions-------------------- Contractor's Name-------------- -------------------------------------------------- ------------•--- Phone--------•-------•-----•----------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms - 75 t x12 ------------------------------------- ._ Water Supply:. Public system ElCommuriity system ElPrivate [X Depth to Water Table -].2_ f;t. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑_`lay ❑ Adobe k] Hardpan ❑ Previous Application Made: Yes ❑ �No ® New Construction: Yes ElNo ® FHA/VA: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation_____---_________-.Material -----------------...__________________ l EX � No. of compartments Size Liquid depth-------�------- Capacity I ' � l- ing it �I - t t t �Q___-----Distance to nearest logr,g ______________ Disposal Field: Distance from nearest well------- from foundation -------------- I `++ Number of lines-J-------1--------~----- :------Length of ea6 line------------------ij---------Width of trench------------------------------------ Type ----------------------- r ® r - R - / – ! Type of #iltee material____- _ S? _Depth of filter matenah____lg_____--____Tota{ length__----____ Q_____--___________---- I t t t I x7---7 Seepage Pit: Distance to nearest well--------8Q._--_-Distance from is��_._______.DistanceJo n4l es lot lin 50----. 4 r ROGk_-----Size: Diameter----, th_-.-- ----- -- x-- � ❑ Sump Number of pits-_:-----�----------Lining mate rial---____-- p Cesspool: Distance from nearest well_________________Distance from f_oundation____-_--,:,--:----Lin�ng material_____._.._-__..______________-______. `- .�._. .. .. w-- —. Li uid Ca acit ❑ Size: Diameter --------------------------Depth;-------------------- ------------ ------------ q� Capacity gals. Privy: Distance from nearest well-------------------------------------- --- -----Distance from nearest building------------------------------------------ ❑ ., --------------------------------------------- Distance to nearest lot line-------------------------- - ------------------------------ f Remodeling and/or repairing (describe:-------------------- -------------------------- i I N' ---------- ------------------------------------------------------------------------------------------ ---------------------------------------•-------------------------------- ------------------------------------------------- ------------------------------------=------------------------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. P rr-io-h & So-n-s --_----------------------_----[Owner and/or Contractor] t By:---•------------------------------------------ 11 __ 1Wright------------------------------------------------------(Title)--- --E-S----x- ------e -= [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -----� -------------------------------------------------------------- DATE------ ----- �-�------------------------------------------ REVIEWED ---- ---------- -------------- -------=- REVIEWED BY------------------------------------ --------- -- - DATE-------- '= BUILDING PERMIT ISSUED--------- - DATE---------------- - -d ;-------------------------------- ------------- -------- - ----------------------- -------------------------------------- Alterations and/or recommendations:--------=------ ----------------'------'---------••--------. __ -------•----------- - --------------------------------------------- -------------- --- ----• --------------------------------------- FINAL' INSPECTION BY:---- Date---- ..�:_-------_ -- - ----- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stre®t 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi California Manteca, California Tracy, California ES--9-2M , Revised 1.57 F,P.CO.