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FOR OFFICE USE: Permit No. ..--•••----- ---------- ------------------------------------- " APPLICATION FOR SANITATION PERMIT / ------------------ -- ------------------------------ Date issued _ ,,,,,,�,��(Complete in-Duplicate)_,,,-�..,..�..�_, This Permit Ex ires 1 Year From Date issued . Ira0<04 to the San�Joaquin Local Health Disfric#:fora permifi to construct and install the work herein described. Application is hereby made 1 , This application is made in compliance with County Ord i+encs No:549. r ,t t JOB ADDRESS AND LOCATIONy Phone------------------------------------ Owner's Name r`__ �G -; 4" --------- Phone ----------- Address ------- -- + =------------ Commerc+alT�ai4er Court ❑ Motel ❑ Other ❑ Contractors Name--------0"�--�- -- -= •---•--- --------- -- - A Apartment House ❑ ❑ : l 4 Installation will serve: Residence P ------------ Number of living units: -_�----- Number of bedrooms .-� .Number of baths � Lo#..size __>�-�--�-€��7• -�.---------- t - � j Private ❑ Depth fo Water Table -------- ft. Water Supply: Public system Commuriitjr system ❑ Loam C] Clay ❑ Adobe® Hardpan ❑ Character of soil to a depth of 3 feet:f Sand ❑ Gravel ❑ Sandy Loam ❑,. IClay New Construction: Yes No ElFMA/VA: Yes ❑ No Previous Application Made: (If yes,da€e-------------- ------) No TYPE OF INSTALLATION AND SPECiHCATlONS: t (No septic tank or cesspool perrrsitted if public sewer,is available within 20U feet.) t - _ MatervaL"C_EA-�O.O- -- ----------- Sepfsc Tank' Distance from nlea est well_3C1�Y►�--Distance from foundtion___�'-b - Ca acitO ----- t x �r Liquid depth -4- --------- Capacity No. of compartments----_-------------- --Size_ __i�--- r f Distance from found ion._ 'i_0---___'.Distance to nearesfi lot lintre_"_�-�----• Disposal Field: Distance from nearest well._141J�E" Length of each line_ 6i�-t36---Width of trench_-_�.-B -.--- Number of lines__-__ ••-----f k Depth of filter material____. 11_F__--Total length--- _1-50g filter matenal!5? I"$ f > 1 teance from founda#ion_____!_�JI___-__-.Distance to nearest lot i�ne____ - ------ 11 Seepage Pit: Distance to nearest well YhD"44�---- i -Size: Diameter---V--X-B........ Depth_ --- '"----- """" Number of pits------Z-.�---------Lining rnat ria15L>�- Cesspool; D istance from..;nearest well-----------------Distance from foundation._.______--___-_.Lining material__-__---____-__--_-_--_________.____. ' Det #h-- ._ -Liqui"d Capacity-- -------------------------gas. Size: Diameter-:} --------------- I ---Distance from.Inearest building------------------------------------------ Privy-. -------------------------- ------------ Privy: fromnearest well --------- ---------- - - " -- --------------------- --------------- Distance fonBarest:lot ------------- 0 ins ----- -- ---- ❑ ----------•---------- ------ I ----- ------ ---------------- J {---- ----------- - Remodeling and/or repairing (descr+be�:--------- � ------------------------------------------- t -------------------- -------------- - I -------------- ---- done I hereby certify that I have preparreduiais ns application and the San Joaquin i h work cal Heawill lth District accordance with San Joaquin County ordinanceStataws3and ules and r g --(Owner and/or Contractor) --------- -- (Signed) .{ - By:--------------------------------- ---------- -------------------------- e placed on reverse side). [Plot plan, showing size .of lot, location of system in relationto wells, buildings, etc., can b FOR DEPARTMENT USE ONLY --- DATE--- ---------------------------- - APPLICATION ACCEPTED BY_ __-- -,---- DATE---------------------------_----------------------------- REVIEWED ----------------------"" -- REVIEWED BY------------------------ ------ ------------ DATE------------------------------------------------------------ __ _ __ ______.____.______._ __ __ V. 4 _-_ -_ y BUILDING PERMIT ISSUED-- Y _ --- -=------------- --- ---------------------'--------------- ---------- Alterations and/or recommendations:___--------------- - ------------------------------------------ I _------------------------------------" i ---------------------------- ------------------------------- -----------------------i--------- {-------- ------------- -------------------------------- ------------------- -!� Date---- -------------- ----------- --- ----- FINAL INSPECTIONBY=-------- --------- -- -- ---- - y SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1501 E.Maxeltan Ave. 300 West Oak Street Tracy,California Stockton,California Lodi,California Manteca,California ES 9 R6VISED 13-59 3M 3•'63 F.P.C13.