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FOR OFFICE USE: h Permit No. -------------------------------- -------- APPL1CATlON FOR SANITATION PERM] '� ------ ------------- (Complete in.Duplicate] ' .Date issued.� � -----------------ii ---- -------------- ------ This Permit Ex ices 1 Year from Qate issued - made to the San Joaquin Local Health District �9 a permit to construct and install the work herein described. Application is hereby This a plicatiori is�made in compliance with County Ordinance o. ` ��c ac-6-1-12-11 " �," B DDRES AND LOCATION- / � lc� �'l -------- l '4 _ R�?_ K. . IONS �" JO , --------- Phone.----------•----•------- - -- -------------------------- ---- Owner's Nam - -------------- ---------------- - ------•----- 3 ------- Phone --------•-•-------- - Address----... - --------•-- , y - ---------------- 0 -------------- ° --- Contractor's Name ' Motel ❑ Other ❑ Commercial ❑ Trailer Court ❑ Apartment House ❑ _---_---_-_ Installation will serve: Residence p -- _ Number of baths ___:_.-- Lot size _--�-� Numb 'of living units: J_ Number of bedrooms _�- # Private Depth to.Water Table -------- ft, Hardpan ❑ Water Supply: Public system ❑ Community system ❑ Adobe❑ Gravel ❑ Sandy Loam[Clay Loam ❑ Clay ❑ F ' ii No ❑ FHA/VA: Yes ❑ No ❑ Character of soil to a depth of 3 feet: Sand ❑ New Construction: Yes ❑ Previous Application Made: ,(lf yes,date---------- No ❑ -L , TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 260 feet-- Material------------- _--------------------------------- Distance from nearest well-----------------Distance from foundation"__._______--_- Capacity I Septic Tank: -Size--------------------------------Liquid depth-------------- ---------- Cap Y e ❑ No. of compartments-------------- � � � Distance from foundation___.___jC�__.--.--Distance to nearest lot-eine____,�r--------•- r ------- Dispos field: Distance from nearest ll-- r Len th of each line--_ -G -� Width o trans _.._-- II Number.of lines------------- -- ----.------------- g m _De Depth of filter materza!_.__.�- ---- Total length_____" =- ------------------ Type of filter material._-_ p Distance to nearest lot line------------•--• C 1 i G i Seepage Pit: Distance to nearest well..___-".____- .-----Distance from foundation______________ _____ It Number of pits----------------------Lining material---- 5't onDiameter----Lining material p- ----= - _-_--------�/. ii ❑ ---gals. Cesspool: Distance from nearest well__"--------------Dis#ante from fours a -Li Liquid Capacity.-----------= I ❑ Size: Diameter--------------------------------------Depth-------- ----- ------------------------------ q i 10 Distance from nearest building----------------------------------- -0 ----------'---------------------- Distance Privy: from nearest we ------------------------------------ ---------- - _ . ] ❑ /Distance to nearest lot fine.-..__-" -- --------- 'h l ° "1 ' Remodeling and/or repairing (describe}: + -------------•----•--•-------------------------------"------- I .M...e.F --------------------- ---------------------- ---------- '= ---------------------------- = - q -------------- ----- ---------- ----------------- ty hereb certify that l ha prepared this application and that the work will be done in accordance with San Joaquin ours I Y 3 �ordinances, State laws, and ules and regulations of the-Sam �- - - --- — and/or Contrector] !i _1--- -------------------- ---- ----------------- i(Signed) to relation to wells, buiidi# i ` 9 ) ---------------------------------------------- -------- ----------------------------5'------------- (Title) ' n s etc., can be placed on reverse 'de]. i (Plot plan, showing size of lot, location of systemFOR DEPARTMENT,USE-ONLY h .-DATE------ a—I f�*------------------------i- --------- l APPLICATION ACCEPTED BY--- - - t DATE----------------:------------------------------------------ REVIEWED BY_ ------------------------------------ ------------- ---V _ ,DAVE------------------------------------------------------------- - - --------------- ---------------------------BUILDING PERMIT ISSUED-------------------------------- ------------ "-- � -+. - ti ------ ------------•--- E; Alterations and/or recommendations: - - - = -•-----------------------------------•- ---- ----------- r --------------- ----------- -------------------------- -- --"-----•---------------------------- - ----------- ---------- ------------- ----------------------------•-•"_----- .. w F --- -------- Date--------- -- -- ---~--•d------------------- - ff FINAL INSPECTION: BY. ---- E SAN JOAQUIN LOCAL HEALTH DISTRICT 'j 144 Sycamore Street 205 West 9th Street 1 300 West Oak Street Tracy,California 1401 E.Haseltvn Ave. Manteca,California Lodi,California ] Stockton,California Eg 9 REVISEp a .9 3m 3-'63 F.P.CO.