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r( t OR--OFF ; v ,. Permi o. ..l.. ,. APPLICATION 'OR'SANITATION PERMIT _ �Z, ---- -- ----- Fi (Complete in Duplicate) Date Issued : .'------------- "--------------------- yf-------------- This Permit Ex fires 1 Year From Date Issue - b made to the San Joaquin Local Healfh Dil�oc 549r a Permit to construct and install the work herein descn e . Applica+ion is hereby ------------------ This application is made in compliance'with County Ordinance 'I 9 ---- = --------------------------------------- ---------------------- - - ------- b�' -� Phone --------------------- 0 = til 30B ADDRESS AND LOCATION+ Cr , � --------------- -------•- - Owner's Name _ . -J_S_- -- -m'e't-- - -- , -.. one------------------------•---- Address.--_-".. - ❑ - "`" Other ' ------------- -------- •--•-- - •-•• --------------- - Motel ❑ Contractor's Name---- Commercial ❑ Trailer Court ❑r installation will serve: Residence [� Apartment House,❑ QXD " " ---------------------------- installation ------ ----- Number of 4iving units: --:�" -- Number of bedrooms _.2 Number of bfih+o- ate°78�1a -�_{t: r I Public system [_Community system ❑ Private ❑ Dep Adobe�ardpan ❑ Water Supply: ❑ Clay Gravel ❑ Sandy Loam ❑ Clay Loa l No El❑FHA/VA: Yes ❑ No E Character of soil to a depth of 3 feet. : Sand ❑ eNew Construction: Yes lv� date.---- - } NoJ Previous Application Made: llf yes,i TYPE OF INSTALLATION AND SPECIFICATIOublic sewer is available within 200 feet.) ir (No septic tank or cesspool permitted if p U x x q Li uid depth----% ---- ----------- Capacity 'l Septic nk: Distance from nearest well.._---:--------Dis#ante from foundation__-�?-•---- -----.Mate iia -- -- ---- ---- ---- - --- ------------------ No. of compartments_ S'sze q t well._- Distance from foundation-14!-r-------.Distance to nearest lot line---"_---- Disposal Field: Distance from.-nearest Length of each line ------------ ----------- .Width of trench._`- -_ �� t Number of lines------- -- ----------- otal length_____9 ? ► _- De th of filter material._/+ --- t Type of filter material_ - P -----.Distance to nearest lot line ---• 2 [ Size: Diameter.-----'33." -----Depth--- Seepage Pit: Distance to nearest well.---------------Distance from foundatio -- Number °f pits_-- -- Lining material---/----- ---- -----. t ❑ --- - - Distance f omtnearest well----------------- from foundation--_ . Liquid Capacity_-.----------------------"-gals. 6 � Cesspool: Depth e ❑ Size: Diameter- ---- ----- ---- ---- --............ - ---- -- ---- G Distance from nearest buil ing--- -------------------------------- Distance - ---- ----------- ""-"""--- l Distance from nearest well-- --------- ----------------------------------- --------------- ---- - --- --------------- -------- ---------- I Privy: ---- ------------ ❑ Distance to nearest lot line--------------- ti ------------------------------------ Remodelin and/or re airin ." - --------------------------------------------------- - -------------------•--------------- ---------------- --------------------------------•------- - a a ui .� application and that the work will be done in accordance with San Joaquin County 1 hereby certify_fhaf I h ve prepared this ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) I I -- (Signed)----- --------------------------- h + (Title) ' .._ -------- ------------------- g P Ian, showing size of lot, location of system in relation to wells, buildin s, etc., can be laced on reverse side). (plot i' .� FOR DEPARTMENT USE ONLY ' DATE_. ---------------------------- _... DATE------------------------------------------------------------- DATE ACCEPTED BY'..- -- ------------------ REVIEWED BY_ ! BUILDING PERMIT ISSUED------------------------------ ------------ - DATE -------- - ----- ----- _� . '_ f= " --- -------------------------------------------------------------- --------------- Alterations and/or recommendations:. ------------------- ------------------------------------------------------ �.�� ----------------------------------- -------------------------------------"------------------ .r ._ ------------•----------- ------- -_ ---------------------------- ---------------------------- `t ------. ---- - ---------------------- Date ------- .............. FINAL INSPECTION B : - - - ------------- - ------ -= _ ---------- - --- ----- SAN --SAN JOAQUIN LOCAL HEALTH DISTRICT 2 124 Sycamore Street 05 West 9th Street 300West Oak Street Tracy,California 1801 E.Hazelion Ave. Lodi,California Manteca,California Stockton,California