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FOR OFFICE USE: 0 D Permit No. z;ed 7 " �c fAPPL,ICATION FOR SANITATION PERMIT --------------------------- --------- (Complete-in Duplicate} __ � -.w Date Issued -------"- - - - --------I ---- -- _ --- -- This Permit Expires 1 Year From Date tissued i made to the San Joaquin Local Health District for a permit to construct and install the work hereiin descrbed. Application is hereby ;I This application is made in compliance with County O17 rd'sriance No. 544. JOB ADDRESS AND LOCATION-60- 0 OCATION- 412---®A��:4W/W Owner's Name f/�•- 0.------1-A_ --- GRoa�]ej�- --------- --- Phone---------------'------------------ . - - ��- --- -- Phone �7-------- --------------------------------- - Contractor's Name-------- Motel Other ❑ i Installation will serve: Residence ❑ -Apartment House Cl Commercials Trailer Court ❑ ❑ 1 Number of living units: _- ----- Number of bedrooms Number of baths-------- Lot size _ __ _ -- _ Private Water Supply: Public system.K Community system C1 ❑ Depth to Water Table 70-'ft I Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ a No ❑ Previous Application Made: (If yes date_.._"------- -----�• 7 Na E] New Construction: Yes F1 No El FHA/VA: Yes ❑ r i 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 quid depth. Material Capacityi }~ ❑�1C}5-!�l�� No. of compartments.__ ._ __.. ._. � _Distance to nearest lot Disposal Field: Distance from nearest wel!_J�9lI) --.Distance from foundation._. -�- Width of trench__ _ --rr------------------ Number of lines---- ----_ !��_ Length of each line--�f.��J-- f� / r { , Type of filter material Depth of filter material____/-I---------�Total length_"__.__{-- `V i 1„3-0.___ Dist e to nearest lot;�ineo.,le - N Pit: Distance to nearest 11well_ V1.�1��'.-.Distance #rom f ndation__ ._ Number of pits.f� -1.------------Lining material-- -�'- -- Size: Diameter.- -------------Dept'n_c�Z ----�----•------------ Seepage I Cesspool: Distance from nearest well _._._..--------Distance from foundation._-...- Lining Cmaterial... eacit i^ gels. ----Depth------ -------- ------------- ----- ------- ------ f_1 -- q Capacity } ❑ Size: Diameter- - ----- -- ---- ------ -- Distance from nearest huildin9----------------ii------------.- ! Privy: Distance from nearest well_--.-"------------------ ---- ...... ❑ Distance to nearest lot line ......-............ --------------------------- - ------------------- -- --------- i -- Remodeling and/or repairing (describe):------ -._ - _-__ ---- ------------- ---- F ---- ------------------- --------; ------------------ ---------- --------------------------- ---------------- I hereby certify f a e prepared this application and that th work will be done in accordance with San Joaquin County d regulati fis of the San Joa ui Local Health District, ordinances, State laws and r es an (Owner andl%or Contractor) (Signed) Title s--- ---I....-.. BY ------- - (Plot plan, showing-Size o lot, location of system in relation to weNs, buildings, a#c., can be pla don reverse si ell FOR DEPARTMENT USE ONLY nn pp ODATE------ -!__1_" -l.--------- -------------------------- APPLICATION ACCEPTED BY._--- DATE-------- !--------------- --------- REVIEWED BY-- -------------- -------- ---- ----I._------------------ ----------------- BUILDING PERMIT ISSU.ED-----------------------"-------- ------------------- ---------------------------- DATE - - - ll Alterations and/or recommenda i s:_..-. ------ - - ----- ----------------------------- I'l ------------------- ----- -------------------------------- - --------- ------ 'I ------------------- ------ ------------------ ..- ------ -------------------------------------- ----------------- -- ------------ "----------------- y . y� Date... ----. >- - ---- 1 _..4__.x..-. FINAL INSPECTION BY:-._. - --�`=-- -----`-�--- ------- d F SAN JOAQUIN LOCAL HEALTH DISTRICT F1 300 weal Oak Street 124 Sycamore Street 205 West.9th Street 1601 E.kazelton Ave. Trac Lodi,California Manteca,California y,California Stocktan,California EA 9 2M 1-67 Vanguard Press i i