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FOR OFFICE USE: ,-t o Permit No. -•l-` "' `� ----------- APPLlCAT10N FOR SANITATION PERMI Duplicate) Date Issued-•---- - ''jo--------------------- -------- (Complete in Dup' � ---- ---"" -------- This Permit Ex fres 1 Year From Date Issued ----------- �-, - x - ""�-- " an Joaquin Local Health District for a+p�rriit�to CO nstrue# and install the work herein escri Application is hereby made to the S { Y fiance with County Ord inan- No. 54 / This application is made in comp / ----------------------------------------- ----------------- C -- .-----_--_•------------ ----- a -• Phone- ----• ------ f----- ----- ------ on J08 ADDRESS AND LOC ION----- - ---•- '------------ ---------h= - --: - --------------........ •-1•,_�•-•�,�-- - , - - --------------- - Owner's Name------ . - I i ------- • _� " Phone----------------------------------- - - ...---•-------------- Address /.- --------- ---- Co Motel ❑ Other ❑ . Contractor's Name.-.-"'---------- s mmercial ❑ Trailer Court ❑ �A artment House ❑ Installation will serve: Residence i p ----- Nu lber of baths -f--- Lot size -=- / , De t}i�to Water Table _ ft. Number of 4iving units: _- Number of bedrooms _- [� Community system ❑L. P e ❑ p Adobe . Hardpan❑ Water Supply: Public system. t Sandy Loam❑ Clay Loam ❑ - Clay ❑ No 5— Water of 3 feet: Sand❑ Gravel ❑ No �FHA/VA: Yes Character of soil to a dap 1� New Construction: Yes ❑. , Application Made: (if yes,date------ 1 �t- I Previous App t w ublic sei Tis available within.200 feet.) TYPE OF INSTALLATION AND SPECIFICATION : Material (No septic tank-or.cesspool.permitted if p Capacity------- -----------•-• iI +bistance from foundation_- r Septic Tann� No aof compartments well - Sid e------.--- Liquid depth--•------ = -------- I Distance to nearest lot line_- .--.--- I d 5 ► Distance from nearest well,_-_"_."-.-.-----+Distance from foundation-------------------- Len th of each.line--------------------- --------Width of french pisposal Fief d: s ------------------- g � 7��y Number of lines-----• th of filter material----•------ f. .To#al length-------------------------- Number -----•-- _ _ ----_----- Dep of line.-_•------•-•--- ' � Type of filter material-----"--" •_,De th__.- � ` Distance f m foundation__ >�,q„ `-____-.-_--.__.._ -.Q__----.-.Qi t nee to nearer i Sixe: Diameter"-- p Distance to nearest well # �j I Seepage Pit: - . :`- g l -X.t �r{�.- 1 Number of its--"------ gals. •,•1 i once from nearest well-----•-----=-----Distance from foundation-------------------Lining material--------------------------Linin maeri } # Dist ---- ------------------------ cesspool: --Liquid Capaci#Y------------------ ----•-•-• -s .., - - Qe kth------•------------ Y. Sixe: Diameter---------------------- -t Distance from nearest building----------.--•-------- ❑ ----- - Y -------------------------------- Distance from nearest we ----"- Privy: _ --------------=i 1❑ .� ---•- I E ---"" Distance ton� o ine--__._-�.�-•�i�Ti- -- - --- - -- - ----------•-•------- ----- 1 - ------------•-------------------- ----•----------- Remodeling and/or repairing (describe):6 - - I t } ------------------------- -I------ '---"----------_ lication and that the work will be done in accordance with San Joaquin County ------------------- - 'prepared this app I hereby certify that I have:.p. p jCgEMS5sWor Contractor) ordinances,I here, State laws, and rule's and regulations r the�San Joaquin Local Heat/}h District. ----- -, --- - ------- - ------- (Signed)----- - _ [Title) --------------- - - -- - I - ---- - --et - laced on reverse side). I - . ----- .r buildings, etc., can be p By: s in relation to wells, [Plot pian, showing size of lot, location o Sy1. s _ w Y FOR DEPARTMENT USE ONLY i t ✓ DATE.,)J-'-�------ -��C --------- ------- � c ---------- DATE APPLICATION ACCEPTED BY.-- -- ---- ---. IT ISSUED ED---------------------------------------- - ---'.-.•-------=------ - DINE.---------------•------------------------------------ - --------- s ING PER ? ---------- Alterations ons and/or recommendations:----- "" - _ ------ ------------------------- -,-j` 3 --- ---- ------- -- ----- ---- - -------- •---------------------- ------------ Date - - Y , "Date----- 4 --- - FINAL INSPECTION 'BY:._.- -- UIN LOCAL HEALTH DISTRICT sos West 9+h Street SA I NJ S 124 Sy�m�o`re S+r,et Tracy California F 300 West Oak Street Manteca,California 130 South American Street Lodi,California i stork+onr California (_6.9 REVIBEC B•59 r.P.cn.2M 6.50 } -