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FOR OFFICE USE: �3 ----------------- /-- -- APPLfr3ATIQN FOR SANITATION:PEWIT Permit Na.c�l�+�`�•- '�d ------------------------------ � , ~ Y ' "�Complefe in Duplicate) Date Issued--:-------------~ -- 7 This Permit Ex ices 1 Year From Date Issued Application is hereby made to the San J / PP Y Joaquin Local Health District for a permit to construct and install the work herein describe . This application .is m_ade in compliance with County rdinance No,, 549. 147 3— f? ^� - PP1 [- -5 ,2Du �- >��2 :-� .. __ � 1.�.1� �'-!---�'z--- . JOB ADDRESS AND CATION___- - _ ` w 1 Owner's Name------------rf ' � - -- - --------- --_-- ------ - ------- - Phone��-��- ------ Address-----•------- , Phone � fl_:, Contractor's Name--- --- �--- -- -- - —- ---- - 6 �- - - ---- -- - Motel Other l(Apartment House ❑ Commercial Tra'er Court ❑ ❑ � ` Installation will serve: Residence ❑ p ❑ Lot size _ �c� --------------- Number of living units: : Number of bedrooms __%"'- Number of baths -- , Wafer Supply: Public system ❑ Community system ❑ Private epth to Water_Table -------- ft. N l Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sand Loam` Clay Loam [3 Clay ❑ Adobe El Hardpan [ `` Previous Application Made: (If yes,date----------- E]-----) No New Construction: Yes E] No' HA/VA: Yes ❑ No ❑1-�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.} r Septic Tank: Distance from nearest wll_ ---Distance fr�P fo aYio f� C _Capacity---e `_ Liquid dept . P Y No- of compartments___ -----------------Siz .__ -- ____.Distance ,#o nearest lot line,f_____. -- D'sposal Field: Distance from nearest well-� -_.-Distance from foundation___ -- Width.of trenchs. _ ----------------- Length of each line_- -�--- - Number of lines__-�_.___ -- ,?- .9 • s/ �- f e-th of filter material_-- /-__ ---'- -------Total length Type of filter maferiai � P "l ` � Seepage Pit: Distance to nearest well..._______________ _Distance from foundation--------.-------.---Distance to nearest lot ine.------._..._.... 4 ❑ Number of pits - Li.' g material------------------ ----Size: Diameter Depth Cesspool: Distance from nearest well-----------------Distance from foundation---.-----__.-._--_.Lining material__..___._._.-.._____.__.______._--s Li uid Ca acit gals. C. ❑ Size: Diameter--------------- ----------------- ----Death--------- -------- --------- - G Capacity Privy: Distance from nearest wet!_____--------------- - ------------------------Distance from nearest building---------------------------------- ❑ Distance to nearest lot line------------------------ --------- --------- ------------------------- ----- Remodeling and/or repairing (describe------------- --- ---- --- / - ' d. - � __. _ -------------- ---- I hereby certify that I have prepared this application'and that the work will be done in accrdance with San Joaquin Count ordinances, Stat laws, and rules and regulation of the San Joa .n Local Health District. + -Contrac IT (Signe .✓ (Title)- b r •-- •------------------- ----------- '{-----� =--- --------- -- BY: 1. (Plot plan, showing size of lot, location of syst in relation to ells, bu' ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY °4 r --------------- APPLICATION ACCEPTED BY _. ._ --. DATE_ - -------•--- DATEK'--- ------- '-- ---------------------------------- ------ REVIEWEDBY------------------ ---------------- -------------- -------------- -------------- - DATEu: ._ ' BUILDING PERMIT ISSUED.------------------ ----�--------- f r - - ------------------- „ = 7 �----"------------ Alter ions and or recommendations:_- .� „ --- ------ ---------------------- t -------- 7 . Y= — 0_ - - ----------- .�- v :w -----�-�_. .---------- -------------------- ------ 4 c /7T �� FINAL INSPECTION BY- ..-- - -"-p---- -- -- --------- -------- Date------- ,----•--- --- ---- --------- -------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycaritore Street 205 West 9th Street 1601 E.Hazelton Ave. California Lodi,California Manteca,California ` `-� �., Tracy, Stockton,California {`