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FOR OFFICE USE: ` ----------- APPLICATION .FbR SANITATION PERMIT Permit No. .r��`1 .l � ------------ ---------------------------- --------- ,- �. ----------------------------------- (Complete iri Duplicate) Date Issued __�4'h � -- - This Permit Expires 1 Year From 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. OG •-1r✓►-utj--- a-u- d----:------------c�Toc>��}----------------=----- JOB ADDRESS AND LOCATION..{______________�__g - , � ------��-_-�=,.A.Phone-----•�-----------------•----------. Owners Name---------- EVI,, -q=� -----•r••----M--------- -f Q•N -,' ,.':_-- =------- �i } O -----`--- - Address--------------------3--g- # -- j ...f. I - �' Phone--- ----------- ------------------- Contractor's Name-. cs`'.�. L 1F-1Trailer Court Motel ❑ Other ❑ Installation will serve: Residence � 'Apartment House Commercial ❑ ❑ t _ r } ---------------------- Number of living units: -------- Number of bedrooms 'Z... Number of baths -------- Lot size -G-K-------C-- Water Supply: Public system El Community system El - Private% Depth to Water Tabi �-_ ft. I Character of soil to a de4. pth of 3 feet: Sand ❑ Gravel F1 Sandy Loam [I Clay Loam ❑ ' Clay ❑ Adobe Hardpan ❑ # , t , Previous Application Made: (if yes,date---------------_---I No El New Construction: Yes ,� No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATIONJAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---- ---------Distances from foundation.......�.a-_--.Maters�._ '-� ' - - -- - r- Liquid de th.----- % ------------Capacity_11_6�P_7__ g X . No. of compartments-.___-- Size1Qt�'tS._-X-- - ---- G P• r t of °� � � O Disposal Field: Distance from nearest well.---- ..-_--Distance from foundation.... --..._.,._.._.Distance.to nearest lot lit(.... ....:..... Length of each line------- Width of trench-------_ .__. Num6er�of lines�tr_-_;.___._- -- g _ �j l L „- '..I., y- Type of filter material___, ._acb_K._---Depth of f Iter material_-..1_. - Total length...__-.... a---- ---------- Seepage Pit: Distance to neatest well=---------------_---Distance from foundation------------------- to nearest lot line...------.--.--... C Number,of. pits!------------_-_Lining material---------------------Size: Diameter ry =' Depth El O I Cesspool: Distance,,from tiearesf'weiL....a..77`.....: ..Dis#ante from foundation-------------a-`-....Lining material------___--.________.__._.-------.;.-. v -- _ Liquid Capacity -..gals. ❑ Size: Diameter--= Depth 9 P Y - { i Distancfrom nearest buildin Privy: Distance from nearest;"well--------- --- --- -------------------------_----------- 0 Distance to nearest lot line------------------ --- ------ - ---------------------------------------------- 1-11---------------------- ---------------------------- -------------------------------------- Remodeling and/or repairing (describe):..___..._---------------- --------------- ------�-- p I I ------------------------- ----------------------------------- ----------------------------- i -------------- I --- ---_ R .tea... ,i.... y - Y ------------------------ = I 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. t �� Owner and/or Contractor) d C fca of t e'-f4-S '`-�- ------------ ------ - --------------------------- -- (Signe ]-------- ------- "-�S - /' /l ; +� — ---------------(Title) (Plot plan, showing size'of lot, location of system ' r ion to wells, buildings, etc., can be placed an reverse side]. - ( D PARTMENT-USE ONLY r DATE - ----------------------- APPLICATION ACCEPTED BY--------- - -- =--- - ----- -------- . _ DATE--------------------- - ------------------------------------ REVIEWE.©` BY- ------------- ---------- BUILDIN6 PERMIT�ISSUED-- -------- ----------- ---- - -- - - - qw- DATE-- .. _: ------------------- _. ----------------------------------------------------------------------- --------------------- Alterations and/or recammenda#ions:........................................_--- i ------------------------ -------------------------------------------------- ---- ----- ----------------------•---- --------------------------- -- , II r* } ------------------------ -�. - - ------------------------- - a --------- ----------------- ... FINAL INSPECTION BY:.-----.--''- , ---L1---`-- Date / ..-f--3- ------- ------------------ SAQU1N LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California W _