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r FOR OFFICE USE: 4 — iiq/ �J-1 � -- 1�r _ _. �' 6 APPLICATION FOR- SANITATION PERMIT Permit No. .!11�--$-`�•-- ---------------- (Complete in Duplicate) Date Issued � �� This Permit Ex ires 1 Year From Date Issued I ! 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.-g/ s - ��i Phone------------------------------------ Owner's Name------ I Address------------ - ---•---•------•-•-• '; .S �� --------------------------------------------------------------- ----- - - -------------------------------- -�- Phone - --- Motel ❑ Other ❑ Contractor's Name__-_ • • - , Installation will serve: Residence l"J (Apartment House ❑ Commercial ❑ Trailer Court Q I x I --------- Private Depth to Water Tabled nit system ❑ � ❑ P � Number of living units: __1---- Number of bedrooms -,I--_-_ Number of baths ----- to size _ ft 1 Water Supply: Public.system [�C Y Y Adobe Hardpan ❑ 0 I Clay Loam ❑ : Clay ❑ xF• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y ❑ I No FHA/VA: Yes ❑ No Application Made: (I#yes date_...-...--":---- --.7 No [ New Construction: Yes ! Previous App t ` i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �t Material --------------------------- ISeptic Tank Distance from nare f*,we};___��'__-"-Distance from'foundation-17 Capacity p f ----------------------- Size Liquid P. Disposal Field: Distance fromrnea est we}l _ '.___-_Distance from foundation :�` iDistance to nearest lot D sP Len th off f Iteh material q ..--- . --- ��Width of trench._-011 ❑� Number of lines-----1---- g k'otal length-----9.Q--------- - 1 C�= --- _--De enal.__� 111 Type of filter matenal_� ." P I � ^� from foundation-/0-e----------_.Distance to nearest lot line.------- Seepage Pit: Distance to nearest well. __-.__--Distance ------ Number of pits- "._/.------ ----Lining material`�C._G.A�-------.Size: Diameter__�I�: -----------DePtn----------•----- V Distance from nearest well___,._.____---•-Distance from foundation -------------- F;Lining material___..__.._-------------- Cesspool: --- . -. ian r --- - n tin Ikiquid Capacity- ------------------------ I -----------------•----- gals. ❑ Size: Diameter.{----- ---- - Depth Distance from n�I rest building------------ ---------------------------- t Distance from nearest well-- "-_----.---- - 0 Privy: --------------------------- ---------------------------------------- ----- ----------------- I❑ Distance to nearest loft line................__------ --------------------- 1 . ( ----- ------- --------------•------------------- Remodeling and/or repairing �describey----------------- 0 ---------------•------- ----- ------------- ; -------------------------- - - I------•---------------------------------------------------------- Iltl i - ------------------------ --------------------------------------------- th i �epared this application and a I hereby certify that I have prk t the wowill be done in�accordance with San Joaquin County ordinances, State laws, an les and reg ation of the San Joaquin Local Health District.:� Owner and/or Contractor --------------- ------------------ --------------------------- Si (Signed) -------------------i--- ----- ( g �------ ------- -- -- � Title s --------- --- - ----------------•---------------------- ---- ---tion ---- --- . (Plot plan, showing size of tat, location of system in relation to wells, buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -------------- �f DFATE.LfI'/Z/-.4 6 ------- ----- ---------- APPLICATION ACCEPTED BY- -- ---- ------------ -- REVIEWED 8Y ------------------------------------------- ----------- ----------------------------------- � J ------------ ------------------------------- BUILDING PERMIT ISSUED----- --- --------- ---- ---------------------- - �. • DATE--""--- -C?_-----1�-=.�'S---------:u .e----- - Ih ------------------------------------- ons: -- ----- --------------------- Alterations and/or recommendations:__-.__. � � --_"--___. "___."-------•---------- ------ ----------------------------------------------------- #------- -------------------- ------.------.---- - p " " ------ ------ -------------------------.. ------ ------------------- ------------ -------------- -- ------------ I--------------- -- - ------------ --------- ------------------------- ------!-- - /— - - ----- --------------- Date---- 'l.Jam=�D!�--------- - FINAL INSPECTION BY .--- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 91h Street 300 West Oak Street Tracy,California 1601 E.Hazelton Ave. Manteca,California Lodi,California � Stockton,Gallfornia F.P.0 a. `I