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FOR OFFICE USE: I ------------------ ----- -------- - -- — APPLICATION FOR SANITATION PERMIT Permit No. .-.�110 2 - ------- - "-------- (Complete in Duplicate) Date Issued .�,l-�3-- -� ----------- -----" --------- -------_ ------..----._- ,This Permit'I xpires`1'YeaF'Frorrm Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---1, 4 l 11 t Phone. Owner's Name----hAA,0-----!' .� t Y1.t�L1l�c� •--�?- _. 1 "-"� - -- q,,,, --------------•-•--- ------ - ----------------------------•----------- Address 4 pYJr!� 'K r -' ---------•--- Phone----------------------------------- 'k'� --------------------- - Contractor s Name----- .R.tiO->- ---�..�-�.+�••4--5•------- _. ' Motel ❑ Other Installation will serve. Residence ❑ Apartment'House ❑ Commercial ❑ Trailer Court ❑ L t d �- r Number of living units: -------- Number of bedrooms -------4'Number of baths;; Lot size ------------------ Water Supply: Public system b�, Community system ❑ Private-[] Depth to Water Table ------._ ft. Character of soil to a depth of 3 feet: Sand F1 Gravel [:] Sandy Loam ElClay Loam❑ Clay ❑ Adobe HardpanNo El # Previous Application Made: (If yes date------------------ No F-1 New Construction: Yes F1 No E] FHA/VA: Yes E]t 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_'Y14tl±�.-Distance from foundation---I_D�---__._..Mat eryal__G--E�.+u-IJ--Q--�------------- I ' r . No. of compartments ------Size 4 ]5., _ti[; -Liquid deP.sh Capacity-KO-0. p w . �.... �K 1 -.-Distance from foundation-_----.._-.-__--...Distance to nearest lot line_________________ Dis osal Field: Distance o#ol lines-1 well-----_---------- -------Length of each line__________________.--------- Width of trench-------- -------------------------- El " ---------- — ❑ Type of filter material---------------- -Depth of filter material-_4---------------- length-----------------=------ -------- I I -- st lot line__ _ Seepage Pit: Distance to nearestiwell------------------ from foundation-----_-_.-_-_-.--_.Distance to neare ____.______.__ i ------Size: Diameter------------------- ---Depth------------------------- ----- ❑ Number of pits-1------------------Lining material------.------ --- Cesspool: Distance from nearest well--------t-------_Distance from foundation------------__._._.Lining material_._______.._________________________ Depth---------------------------=------ -----------------Liquid Capacity gals. f 4 ❑ 5izra: Diameter_-'-------------------------------- Privy: Distance from nt f i -.-Distance from nearest buildin �- earestwell-------------------------------- ------------------------------------------- r ❑ Distance to nearest lot line------------------------------------------------------4--------------------------------------- ----- -------------------------------------------- Remodeling and/or repairing describe):_... �-� 1 s ' = - ------------------------------------------------ ---------------------------------------------------------" --------- -------------------- -- ---------- ----------------•------)---------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, g the San Joaquin Local Health District. State laws, and ru es and regulations of . T -------(Owner and/or Contractor] (Signed)-- 1� `------------------------ I - ' - - --- --- - ------ - ---------- ----- ------- - (Title) - (Plot plan, showing size of lot, location of system in 'relation to wells, buildings, etc., can be placed on reverse side). t 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ��--------- ---------- ----------------------------------------------- t4--'5=--b-S------------ ---------------- fDATE-------- --------------------------------------------------- -- ----------- --------------------------------- ----------"-------- DATE------ ----- ---------------------------------I----------- BUILDING Alterations and/orrecomm TD ----------------------- -------------------endations:--__-`�f-s- ----- �-- --------------- --------------------- ---- ------------ ---- _ - --------------------- - ---------------------------------- ----------------------- FINAL INSPECTION BY:.........-. -. -� -•-^-----•^�.--.' Date- ------------- ----- --- ---- SAN JOAQUIN.-LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street r 124 Sycamore Street 205 West 9th Street Stockton,California - Lodi,California Manteca,California Tracy,California