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R OFFICE USE: / Permit No.�/F61-S ------ ------- -�G -. f APPLICATION FOR SANITATION PERMIT I _ (Complete in Duplicate] � JJ- �f�-V P ) Date Issued 1--�--/. --� -- ill-------- ------- -- _-- This Permit Ex fires 1 Year From Date Issued A licationl is hereby made to the San Joaquin Local Health Districtfor a permit to construct and install the work herein described. 9. This app is made in compliance with County Ordi�ianc � � _ —�� s: -------- ; JOB ADDRESS AND LOCATION_--__— --- -- ---------------- Owner s Name------�v-- Address__ :(� - ----------- v t- ------------------ I ) m -ili "1 Con#ractar's Name______ __ ___ __ _ •--- - -- -------- •--• - ------------- Motel ❑ Other ❑ P Installatiottiwiil serve: Residence A` artment House ❑ Commercial ❑ Trailer Court ❑ E Number of living units: -_�-____ Number of"bedrooms _�-. Number of baths Z--- Lot size _____ _CiC_�-P�-G-�------ ------ rR Depth to Water Table ft. Water Supply: Public system ❑ Corr�munity system ❑ Priva#e P Clay Loam' ClayAdobe, Hardpan Q ` Character�of sail to a depth of 3 et: Sand ❑ Gravel ❑ Sandy Loam ❑ Y ❑ ❑FHA/VA: Yes [N No ❑ ' l Previous,Application Made: 11f yes;date--__---.. '1No New Cons#ruction: Yes No ❑ TYPE OF' INSTALLATION AND SPECIFICATIONS: r (N' septic tank or cesspool pe4tted if public sewer is available within 200 feet.) S _ Septic 'Tank: '. Distance from nearest well__-- - �-=-Dista ceyfrom foundation__:_)_--------.Material_: _��Ca aclt�SZ'57 No. of compartments------- -- --- -Size__ \_3C4_Z.-2�._Q_.Liquid depth--- - -- -------- p Y Disposal Field: Distance from nearest well .0----Distance fbm foundation ------Distance to nearest lot line... --------- Len' th of e ch line_2=-- �- -1-- R��Width of trench____-_77 4-------------------- �I --- `~. 9 , Number of lines_.___- -- � 11 Type of filter material ST,.__V-0-G ---Depth of fid r mater�al______f a- --._Total length___Z_ �--------------- Ul I -- � i Seepage ,Pit: , Distance to nearest well �.--------Distance•from foundation___________________.Distance to nearest lot fine_____.-______.__. - Number of pits. --------- -- \,L'ining material------ ----- -------- -Size: Diameter - Depth Cesspool Distance from. nearest well----- ---------Dis#ance from foundation...----------------.Lining material---_------------------------------ - t De th Liquid Capacity-----------------------------gals. ❑ Size: Diameter - ------ - p '� ,� 1 Distance from nearest building-------------------------- � I Distance from nearest-well_. ____.---__,_n_--------------- Privy: i ' ------------- --------- ❑ , Distance.to nearest lot l,ine--------- - -------- ---~ ----�' -------------- --•-------------------------------- % Remodeling and/or repairing [describe.):__.--- ----- V 3 ------------------- A 1 --------------------------------------------------------- �;'`:, I� --------- - ;Ip. ;. , ------- -------------------------------- :.:. h Sa ------qui 1 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. S ----- (Owner and/or Contract Ow d/o Si ned - "C/�/ - = ;I __ - --- -- �*. - �-�.. �' _ (Title)-------- ----- ------ ----------- -- -- ------- -- I By. showing i f lot, location of system in`rel�fion to wells, buildings, etc., can be placed on reverse side). (Plot plan, �t . FOR DEPARTMENT USE ONLY DATE---]7'-`-�- _ .# - APPLIGATI�N ACCEPTED BY DATE------------------------------------------------------------ REVIEWED BY--------------------------------- ----------- -------------------------------- A; :f DATE ------------------------ BUIL A PERMIT ISSUED-----------i------------- -------- ------------ A --------- -`:�, .. _ -�,. Alterations and/or recommendations:__//�� ` _ to _ --- to -- r •- -- � ,arm�f �. . ��I(o-6S `� . z. t 4t +�r Date------ �� Y ----- �� FINAL INSPECTION BY:-----.---- . ----- --- SAN -SAN JOAQUIN LOCAL HEALTH DISTRICT 1601.E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California , Stockton,California