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w FOR OFFICE USE: Permit No. = ------ ---- % � d _�� :'x>_- 'APPLICATION FOR SANITATION PERM _ _�� .(Complete in Duplicated Date Issued ----------------------- --------------- --------- _ _ This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health D' rict for a permit to construct and install the work herein described. Tines application is made in compliance; with County Ordinan o. 549. -------------- ------------------------------------ JOB --------------•----------------JOB ADDRESS AND LOCATIO 1i.a- - a p t ---- ------------------ 7trr Owner's Name------- ------------------------------------------------------- - -----------•---•--------- --..t._ Address one •---•---------------------- Contractor's Name_ -- ""� Motel ❑ Other ❑ Installation will serve Residence Apartment House ❑ Commercial ❑ �Irailer Court ❑ umber of bedrooms - Nurrmber of baths _ ---- Lot size --- -- �R.r---------------------- Number of living units: _-----N Water Supply' Public system WCommunity system El Private El Depth to Water Table �ft. Gravel Sandy Loam ❑ ClayLoam Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ ❑ ❑ vious Application Made: (if Yes,, ........... .....) No E3 New Construction:' Yes ❑ NoA/VA: Yes ❑ No [IPre pP a. TYPE OF INSTALLATION AND SPECIFICATIONS: -� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r --P--------.Matenal--- --- Septic Tank: Distance from nearest well Distance from found fi}on____� /� " `, ..Liquid depth_ '�� Capacety �/{ No. of compartments--Rj----------------•-Siz 9, f f . i _��_Distance from foundation.__i�'�--------Distance to nearest lot line.--�a----••- Disposal Field: Distance from neare -- well./ Width of trench__��!!-------- --------- n Number of lines------- ---------------- Length of each line__ -0--o- "` De tin of filter material____._ ..........._Total length------------------- -- p Type of filter material - I? �r 1 Distance to nearest lot line__--a-------- Seepa e Pit- Distance to nearest well-Al= Distance from foundatioa,�, , ------ �+ g ------Size: Diameter__Z_3 --- ---- Depth._ -- = moi(' Number of gitst.�-r_______________Lining material_"r, Cesspool: Distance from nearest weU_________________Distanc ------Size: Lining Cateacit gals. _Depth------------------------- ------------------ q Capacity - :. ?Y ❑ Size: Diameter-4---- ---------------- ------------ { ----Distance from nearest building------------------------------------------ Privy: Distance from,nearest well------------------------ ---------------------------------- ------- ------------- ❑ Distance to nearest lot line----------------------------------- --------- , 1 . � ,----------•--------------------------------------------- Remodeling and/or 3 repairing {describe)--------- --- --- - - ^i f ;, r �, i �� ------------------------------------------------------ ------- ------------------------ ft -------- ----------------------------I--------------- #--------------------- t =•:----------•------•---------------••---------------------------------------------------------- } l hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' --A--- - ---- -•----- ----------------------------------- ----_ �j ( r Contractor] ! (Signed]-- ------ ------- .-------- - f1 (Title)- ---- (Plot .plan, showing size of lot, location of system in relation to s, buildings, c., can be placed on reverse side). I= EPARTMENT USE ONLY I A ' 7 -------- APPLICATION ACCEPTED BY------------ ----- ----- ---- "` `�' DATE - DATE ------ ---------------------------------------------- REVIEWEDBY--------------------------------------------- -- BUI LDING PERMIT ISSUED-----------------------------------------------•---------------- ----------------------------------------------- --- rL — Alterati sand .or recomm tons•_ ______________ ----•-------- �� r t---------- -- ------- - -------- -------------- --- f / ' ' ------------------- ------------------------------- ----- --------.. .--- Date------- -- --- -•- - - - --------------------- i �pl-;_� FINAL INSPECTION BY---------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasetfon Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street � Stocklort,California . Lodi,California Manteca,California Tracy,California G CS 9 REVISED 5-59 3M 3-'63 F.P.CP.