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FOR-OFFJ.. USE: .. v Permit No. -��L�------•--- ------- ---------- -------------- ------------ APPLICAT)ON FOR SANITATION PERMIT --------------- ---- (Complete in Duplicate) r - Date Issued------------------------------ ----------- This Permit Ex fires 1 Year From Date Issued --- -- -- -------- ----- ------------- ---- - A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereirM Tca ; PP This appli anon is madek, OATticompliance with County��i•�c`�549., � -,•_ �-1 DE. f -------�4[�� -- �=-42 ------F�O�i_ n-a�---R JOB ADDRESS AND LATION--------------------------- - Phone------------------------------------ - ------- -- - - n._ r_.r - ------------- - -------- ---- -- Owner's Name__"_"_""""__ _ ��—�� , - t K --13_q-3------------ - Address------------ = - ---- Phone-------•-•----------•- ------------------------------•------------------------------ i Contractor's Name--""V"4rll_111�R--=----#--•--• Motel ❑ : Other 0 -,'-Apartment House ❑ Commercial ❑ Trailer Court Q .-i r Installation will serve: Residence C4 -z Y. •A5;� �---_.--."---- -" Number of baths Lot size."----- Number of living units: _� "_ Number of bedrooms } r Private 9�ye�pth to Water Table __ - ft. Water Supply: Public system ❑ Community system ❑ Clay Adobe❑ Hardpan ❑ Gravel Sandy Loam or. Loam ❑ Y ❑ Character of soil to a depth of 3 feet: Sand ❑ FHA/VA: Yes ❑ No 411 ilcation'Made: (If yes,date_�95_ -I No 0-- New Construction: Yes �r❑ � Previous App STYPE OUNSTALLAT.ION_AND-,SPECIFICATIONS: •=tee i [No septic tank or cesspool permitted if public sewer is available within 20Q feet.) Se tic Tank: D}stance from nearest well--------- ----Distance from foundati�quFid depth Material_.-- Capacity--.--------.----------- p ` Size"" = 1 f � I�lo: of compartments_.__ _._- .. _ ------Distance to nearest line_" Field: Distance from nearest well.. --�5 - Distance anof from eacline a1 - -------------- - = Width of trench._._. ------------------- Disposal ' � Number of lines--------- -- Length ---------- t ,=Tota! length �D Type of filter matenaL ----Depth of filter material__"".� -_"- g k Seepage Pit: Distance to neo est well ""__.-_in_ mateiale from.foundS`zenDiameter_---Distance tonearestlot line----------------- Number of pits- --- - -------------Lin g ❑ ---------- pistance f�"om nearest well_. __"._" __"_Distance from foundation_______ __ __ ______Lining materia -- Cesspool: Liquid Capacity__. ----- --.-"-- ;-----gals. Size: Diameter------------------------------------Depth-----------'=---- -- q ❑ Distance from nearest building------------ -----------------I... ------ Privy: Distance from.nearest well-- .._- ------------ I ------- ----- - ❑ _Distance to nearest lot fine-------------------- ""__ ..i.+•r_ ------_ - ----------------------`--•--`----------•------------------- G--- Remodeling and/or-re (desribe]: --___---.-.-"""---------- -------------------------------- } ------ --------- -----_-------•----------- ---------------------- ------------------ ----------------------------------------------------- ------------------------------------ -------------- p_- y Y prepared of the San Joaquin Loc work will be done in accordance with San Joaquin County i I hereby rtif thatnldhf le an aregulations lication and that the wal Health District. , ordinances, to laws, a i -----------..r----- --- n {Ow er and/o (Sign -- - --- --- -- - `!s" (Title on roc or --"--------`------------------------------------ = (Plot plan, showing size of lot, location of system in relation to w.ells,,,build'tngs, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY s t DATE-------- ---�--- -'� ----------------- --------------------------- - APPLICATION ACCEPTED BY ` �' ; ----------- DATE--------------- REVIEWED ------------REVIWED BY__. t ------ ------ - - - DATE------------------------- BUILDING PERMIT ISSUED-------- ------------------- Alterations and/or recommendations:-___-_-_---.------- -- , ------------ ---------------;=--i- ------------ --- i •---- -- ------- ------- 0_1,e a------ --------------- - w " ----------------------------_.-. �. ~ `Dte--------------------------------- --- ------ --------------- FINAL INSP ON - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT West Oak Street W 300 es124 Sycamore Street 205 West 9th Street Lodi,California 1601 E.Hazelton Ave. Manteca,California Tracy,California Stockton,California , • P F.P.GO-