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c� - � FOR-OFFICE USE: D..1 f-µ Permit No. �. ------------------ - APPLICATION FOR SANITATION PERMIT �- - ----------------- --------------------------------- (Complete in Duplicate) Date Issued _�_-1 = " ------------------ -- -- This Permit Ex ires 1 Year From Date Issued ---------------- I Application is hereby made to the San Joaquin Local HealthcDiNOc549 a permit construct and o-install the wo erein described. App � f) This applicatian.is made in PI � with County Ordinance I N _ 71J - JOB ADDRESS eA LOCATIO �- - Phone---------------- ----•-------------- ��e-------- - � ''�Owner's Name � ----------------•--------------------•---•-....._.__. -• - - - ---'---•--------------------- ---------•--•--------------------- �I I Address----- ---°- - ---------- Phone------------ ---------------------- C-11 Contractor's Name............. .. . ..... C�`� -----------------------•----- ' Commercial ❑ Trailer Cour} F1 Motel ❑ Other Installation will serve: Residence E3�partment House ❑ Number of living units: .�--- Number of bedrooms --�_ Lot size Number of baths _ ....__ -----•------•---- Community system ❑ Private [Depth to Water Table l -eft• ,_/+ �. Water Supply: Public system ❑ y y Clay Loam ❑ Clay ❑ Adobe �J Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ y I1 No ®/New Construction: Ek-No� No ❑ FHA/VA. Yese-` No ❑ Previous Application Made: (If:yes,date,-....-.....- i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f -----Distance from.fo ndation--�4_.----__.Mat`ial,-.&,r�i Septic Tank: Distance #rom nearest w ll. �...__. � Liquid depth-_. Capacity.rfa�( _-_-• ®/ No. of compartments_I-- --- _-Siz �_ -- G- f ' � / ` �--� - Distance to nearest lat�i - t Disposal Field: Distance from neare well_��-.-----Distance f rom e each I ne (Q � Width of trench.A -_.__,ne__-- .---- _-- -(U) Number of lines_- ----_----- 9 ---------Total length � 5.1 ---------------------- ❑' e th of filter material_, _--- i Type of filter material -_ _ - p Seepage Pit: Distance to nearest well--- _ ------------------Distance from foundation--------------------Distance to nearest lot line----------------- r ❑ Number of pits Lining material Size: Diameter Depth •Cesspool: Distance from nearest well-------------- --DDetthce from foundation----------.__---___Liquid Capacity..-._____--__.-._-.----__.gals. ? ❑ Size: Diameter m nearest building - -------- -- ---- -- -- _ .�,��: ` ` Distance from nearest well----------------------------------------- Distance fro b 'Id ng _ Privy: ❑ Distance to nearest lot line--------- ---------------- ---------- -------- ------- i e :_.._..._ . ----•----------------------•--------------------------------- Remodeling and/or repairing, (descr ----------------------------------•-------- -- ----- ----------- ----- - ---- -----� ---------------------------- _ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 02va Contractor) (Signed) - ---------------------- --- . (Title)-- / - _ --- By------------------------------------------ buildings, etc., can be placed an reverse side). (Plot plan, showing size of lot, location of system in r �iono weils, FOR DEPARTMENT USE ONLY t DATE--- -------------------------------------------------- APPLICATION ACCEPTED BY------ ---------- --- - ----------------------- ------------------------------ ------------------ DATE - REVIEWED BY---------------'--------------------- ----- --------- ----------------- ------------ - ----------. DATE------ --------- BUILDING PERMIT ISSUED.-�------------------ --------------------- Alterations and/or recommen ations:________..__.._._.__.- ----------------------- -------------------------------------------------------------------- ------------- --------- ----------------- --------------------------------------------------------------- ---- >. --- ---- ---- s f — / —�. // 1Y(/✓J Date----.-�----------------------- ---------- --------- FINAL INSPECTION BY ---- ----- --- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.PXQO