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�� . Permit No. _" -• -'......... <br /> APPLICATION FOR SANITATION PERMIT <br /> / (Complete in Du licafeI Date Issued __._3 �.-". ....... <br /> rk herein described. <br /> Applica+ion 'isherebymade to the San Joaquin Local Hdealt�h Dice strict <br /> for <br /> o a permit to construct and install the wo <br /> This application is made in compliance with County <br /> � ccs-I"6 N ---------------- � <br /> JOB ADDRESS AND LOCATION."-------. - Phone-------------------------------- <br /> ---------63-x--6-b---- --------------------------------------------------- <br /> Owner's <br /> Name--•----------�-- .5 C p _ <br /> Address-- <br /> + ?_6 <br /> ------- •-- •--- Phone. <br /> ' Motel Other ❑ <br /> Contractors .Name_________ ❑ Commercial ❑ Trailer Court ❑ ❑ _ <br /> Installation will serve: Residence Apartment House Number of baths ___/-" Lot size -------- 'S r "" """ <br /> Number of living units: -------- Number of bedrooms:?� <br /> Water Supply. Public system Cl Community system ❑J� Private [�bep <br /> th to Water Table .------- ft- <br /> PP y' t Clay Loam Clay ❑ Adobe� ardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ y ❑ <br /> Previous Application Made: Yes [INo [�!N <br /> ew Const action: Yes F1 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �l ata a <br /> ,� No septic tank or cesspool permitted if public seweryis available within 200 feet.) <br /> I . ..� _ <br /> Septic Tank: Distance from nearest well-"--------__. _Distance from foundation_u'�_ e }�--Ma#enal=_---: "=Capacity----------------------- <br /> ----------- <br /> ____ __.�.___.___ <br /> - p. <br /> ❑ b `I �/ No. of compartments-.-- Size q <br /> t I I _ Len th of each line-------------------------------- <br /> Number <br /> �-------.I Width of trench.-------------------=- --- <br /> Disposal Field: Distance from nearest we,l-..-__.-... Distance from foundatibn....-__-._.i... .Distance to nearest lot line_________________ <br /> ❑ Number of dines----------------- --------: 5. <br /> `= Type of filter matenial---------------- -'-----Depth of filter material -- ------- ----Total length--------------- <br /> y .-.�. . ..r / <br /> / G�____ Distance to nearest lot line ------ <br /> Linin material__ 1....-- e: Diamete <br /> r Seepage Pit:. . Distance to nearestlwjell-j _ --g�--,Dispa'riceom.�undati n___ .rte.r....Depth"""-----��--/ " <br /> ®_ Number of pits--------- ------------ { <br /> �. <br /> Cesspool: Distance from nearest well-----------------Distance from mandation__---.--- ----Lining <br /> ed Cat aut gals. <br /> Dept I---- 9 Capacity ------------- <br /> ❑ Size: Diameter---------------------- - - p 1 <br /> 1 g------------------------------------------ <br /> Privy: Distance from-nearest-well._-:__ :,._-....R::_- Distance.from.nearest building-------------------------------------------- <br /> 0 <br /> ----------------- - r <br /> ❑ Distance to nearest lot-line.__----'-------------------• <br /> Remodeling and/or repatring (describe---------------- ----•--------------•---------------- <br /> ---------------- <br /> "-------------------•----------•------------•--•-------------- <br /> -------------------------­------------------------------------------------ <br /> I hereby cert if that I have prepared this <br /> application f the San Joaquin the <br /> workcalHeawill <br /> lth be don <br /> cin accordance with San Joaquin County <br /> ordinances, State laws, and rules a regulations <br /> r, O ner and/or Contractor] <br /> .. --- ------------------------------------- <br /> (Signed) <br /> ----•---------------------(Titl _ s <br /> (Title)--- <br /> ..... <br /> plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse si e. <br /> FOR DEPARTMENT USE ONLY <br /> DATE-------- ----------------------- ------------------------ <br /> APPLICATION ACCEPTED BY._--"""- - DATE--------------- - -- <br /> ------------------------- <br /> `------------------------------------------------- �,7 <br /> , <br /> REVIEWED BY <br /> --- - - - ---- •- -- ------------ ------•----- --------- DATE--------•-------- - -�;-------- ----------------------- <br /> BUILDING PERMIT ISSUED--------------- --------------------------------------------- ---. A <br /> ---------------- ---------------- <br /> Alterations and/or recommendations--------............ ... __-"-___--- <br /> --------- --- <br /> ,� Vfa ------------------ <br /> "� ------- -------------------------------------- ------ ------ ----------------- ------ --- <br /> --------------- ---------- ------- <br /> ------------------------- <br /> --- Date----- ------ ---•---- --- <br /> --------------------- <br /> FINAL INSPECTIONBY:.._-_.---" -- - ------------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> i32 Sycamore Street Si4 North "C" Street <br /> t30 South American Street 300 West Oak Street Tracy, California <br /> Stockton, California <br /> Lodi, California Manteca, California <br /> ES-3-2M 146446 n'rw000 12-54 -- - <br />