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FOR OFFICE USE: Permit No. . --!'• �• ) , APPLICATION FnR SANITATION PERMIT -- - '`L.`----- -------- (Complete in Duplicate) Date issued ------ -------------- ---"--'----------------------------------- ' This Permit Ex ires 1 Year From Date issue Application is hereby made to the San Joaquin Local Health eDINoc for o a permit to construct and install the work herein escrt This application is made in compliance with County Or In �_ ------ 3 9d� ------------------ ---- ...---•--. - -------- ------------- JOB ADDRESS AND CAT10N...-,..---• ------ Phone'.. - Owner's Name----- _ -------------•---------- ;. Address---- �..� ._...__ Phone..- - --- ---------------•-•---•-------•-•- --•---•-• . Motel ❑ Other ❑ Contractor's Nama_.--•----------------•----•••-------'---"•PA/ Commercial ❑ Trailer Court ❑ A artment House ❑ aQ-------------------------- Installation will serve: Residence P ��-4__ -• -- 4 Number of living units: _ -- Number of be _r�-- Number of baths Lot size _._ Depth to Water Tables• ft. Community system ❑ Private ❑ Dep Adobe Hardpan ❑ ` Water Supply: Public system � C1a Loam ❑ Clay ❑ I Gravel ❑ Sandy Loam ❑ Y No❑ Character of soil to a depth of 3 feet: Sand ❑ l No 9-- , �gw Construction: Yes ❑ No Lh" rµpNp' Yes ❑ Precious Application Made: (if yes,�date.----- --,- fes' '� _*11 41 ---�_ _ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feef.) # Distance from nearest well----------------- from foundation--------------------Material-__.._.._.--_-----• .......................--- -- ild: Liquid depth__.-----•-----------------Capacity / • --------------------------Size-----•----------------------�--- q - i t No. of compartments / --Distance to nearest lot line-..... �--•--- Distance from foundatian__.1-�•--• '/ _Length of each Gne__-_3.Q-�.... ... _..Width of trench Disposal Distance from nearest well_ _ - -_ -- r! / Number of lines----- --�------- ----- Total Vength_------••------ \ I Type of filter materials'- �' ``' Depth of filter material-----/-f------- . �, O ----Distance Distance m f ndation._ _D-�•_-.Di�tan�� to nearest lot line.�___5---•- Seepage "t: Distance to nearest well-/! �"' Size- Diameter------ . -----•---.,Depth-------�-�•.............. .. i Number of pits_-_._._l-•----------Lining.material_:_ -Lining Cesspool: Distance from;nearest well---•.--.---- Qettalnce from foundation-------------------Liquid Ca material gals. ❑ Size: Diameter--------------------- p Distance from nearest building Privy: Distance from nearest well-----------------------•------------ ----••------------ ----•---------- O ' Distance to nearest iot line------------------------------------------------ - l Remodeling and/or repairing (describe):----------------------- ................... ----------- •-------------- -------•----------------------•------•----•------------ -•--••------ .•. •----------------•------------------•---•--------•-------•"-•-•---•---••--••-----••--••---------••-----•------••-------•------- 1 hereby certify that I have prepared this application and the the work will be done in accordance with San Joaquin County ordinances, Ste laws, an rules and regulations of the San Joaquin Local Health District. ---------6___ ner and/or Contractor) Si ned ( 9 ) �; ' (Title).. - -------- EY� --------- ---------- ------------------------------------ '.4 etc., can be placed on reverse si e. (Plot plan, showing size Of lot, location of system in relatio to wells, FOR DEPARTMENT USE ONLY moi— APPLICATION ACCEPTED BY_' ," uz_ t- -------------------- ------------ ---------------- DATE--------• - _ f i ----------------- DATE---•---•-----...-------------------------------------------- REVIEWED BY---------------- -•--------•----------- - - ------ DATE- -------------- - BUILDING PERMIT ISSUED--- k` ---- -----------------------------------—.-----------_----- r AFFerations and/or recommends#ions:_` � " . ._.x_ _... . Lo --- --- ------------------ .. ----------------- --------------- I , . TIONB �. Date-------- ) ---------------------••-------- FINAL INSPEC € SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t loll,California Manteca,California Tracy,California ES 9 REVISED 9-89 YM 5-61 ATLAS