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N FOR SANITATION PERMIT Permit No. 'g,�!_14- C� APPLICATIO `S'v / (Complete.in_Duplicate) Date Issued - J Health District for a permit to construct and install the work herein described. Application ie to the Saii s ereby made Joaquin Local This application is made in compliance€with County Ordinance No. 549. -------------- f� -- --- P-��-�.�-. (�: Ca.f ! -----R A------------------------------- LOCATIONJOB ADDRESS AND '1C �� I ' � ---------------------------------- Phone----,��J-7-- f z�� .� Owner's Name-------------------------•----•------------- - ------------------•-----------------------------------------------------------------------------------------�g�a�------- Address.-----••----•----- - Phone------'7"--- - ----------------- Contractors Name------------------------------- - Motel C] Other Installation will serve: Residence �` Apartment blouse [ICommerual ❑ Trailer Court ❑Number of living units: Z---- Number of bedrooms 4--- Number of baths .-/--- Lot size ------ De th to Water Table34�t. Ac'.— Water Supply: Public system ❑ Community system ❑ Privated& p Adobe Hardpan ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 feet: Sand ❑New Construction: Yes, No ❑ Previous Application Made: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if pp6l'c sewer is available within 200 feet.) Material--------- . . sr a �� " Li uid de th- �� "' --------,Capacity---- --= :- foun anon_ I Septic Tank: No. of tom artments_---�--------'-----Size__ ''L ---�-- q I p' o Distance from nearest well_____________ aAA / r p '-__Distance from n Dis#ante to nearest lot I-sne______�/�r ., ` .� t---_ _- Length of each line ,0 '- ----Width of trench.___----� Disposal Field: Distance from nearest well--- foun atio `` f Number of lines------- __ -- ) � t; Total 4ength_- - Type of filter material- -r------------Depth of filter material__--1- --- r nearest well_ r ,%._e Distance from fo ndation__/4F7!-•Distance to nearest lot line____ --` -Size: Diameter--._Z_�_-----Depth_-----. Seepage Pit: Distance to _.____a- Number of pits.'-_.1----------------Lining material&Z --- e4— Li Liquid Capacity gals• Cesspool: Distance from nearest well_________________Distance from found tion___.-.__-_.---�----.Ligmg maPna y----=-____--------------�--------� Size: Diameter----------------------- Dep#h ❑ Distance from nearest building--'------------------------ Privy: Distance ',ram nearest well----------------------- ❑ Distance to nearest lot line-------------------------- - ---- ------------ . ------•--•------------------------------ --•------•----------•------------------------ ---------- „ . .. .. � ---------- Remodeling and/or cepa ring (describe): ------ - -- ________________________________________________________________________�-___ - - __ ----------------------------- __________ ___ _________________________________ ____________________________________________________________________________ I hereby certify tat I Ft�ave prepared this�appfication and that the work will be done in accordance with San Joaquin oun y ordinances, State laws, and ules and regulation`s of the San Joaquin Local Health District. or Contractor) . Qw _ � - (Signed)_ --- ------------ • ---- --- ��1 ------------------ ----------------- - Title `' By:________________________________ {c., can be placed on reverse side). [Plot plan, showing size of lot, location of system in relation(toywells, buildings, pOg PARTMENT USE ONLY DATE APPLICATION ACCEPTED BY---- -:- - - -- -- - ----- "--- - --- ----------- DATE--------------------------------- -------- -------•---------- REVIEWED BY ----------------- - -------------------------- BUILDING PERMIT ISSUED - --------------------------•------ ----------------- ------------------------------------------- I---------------- Alterations and/or recommendations--------------------- --- __-___-__-.___.______.__.__._._______.--------- ----- --------•---------- -- - -------------------------------------------------- -- - -- -- --- ------------------------- Date---------- --------------------------------------•---- ------- ------- FINAL INSPECTION BY:_----- --- . - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 300 West Oak Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California ES-1-2M I0-52 Revised W-2100