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FOR OFFICE USE: . � --------~------- �' Permit No. . _-v�__+�..��..- --------------------------------------- --------------- --. APPLICATION 1=0R SANITATION PERMIT ----_- (Complete in Duplicate] Date Issued _` _ } This permit Expires 1 Year Froiti -late Issued If District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Hea This application is made in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION------- --------------------------- -- --- ----- ---- --------- , --------------------------------------------------------- Owner's Name = ---------- -------------- - -- ------- '----------------------------------------- Phone------------------------------------ Address-----------_------------ --------- --- r ` ` [may ° -- Phone.' 7�-- Contractor's Name_ `-._ _____ ^` Motel ❑ Other Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: _1__-_': mber of bedrooms —Number of :baths I__- Lot size __/___-T-U �--�•�'� � Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table b-0 ft. h Adobe ardp n ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ t Previous Application Made: (if yes,date--------------------) No ❑ New Consttion: Yes ❑ NJ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic==tank-or-cesspool-perrnitted-if-p—blie--sew!5r—fs avzitlable ritksin 200=#eet:]~�° �� Septic Tank: Distance from nearest well -_--Distance from foun atior� aterial------- -- ®� No. of compartments____--iZ -----"-- Siz __ j- - Fquid depth tl------Capacity---AO-e . w� I� 0�---.-__-Distance to nearest lot lin ____-__ .Disposal Fi d: Distance from nearest well-_��c�Distance from foundation__.__ 'd+/idth of trench_- --- --- Nunier of lines____ ---- -- Length of each line___ ]- � �# �k r 'y eof filter materiaY - -Depth of filter material___ / _t__f Total length__ ______________ - �= p ? ---r___ Distance to nearest lot line____._a _-- See age P :: Distafice to nearest well._ -Distanroln_ oundationn o YY Seep g .— Number of pits....�__--_------ ---Lining ma erial� - Size: Diameter--- �� _ Depth-_.��"---------- ` , Drstannce f o foundation ------=--------- 9 _ Linn ,material--------------------- ---------- Cesspool• Distance from nearestt will_____________ _ _ _ L� uid Capacity gals. _ � f qs p t y--------------------------(-9a . Size:+Diameter-------------------------------------Depth ;,._`--------"------ ------ - ----------------------------- ----- 1 Distance from nearest well---------------------4.__ ------ -----------------_ istanc from nearest buiiding_( =-- �• Privy: �t -lre� �J -------------------- --- Distarice tovneaeest !d line______ -- - t -- ---- W t -------- --- -------------- Remodeling and/or rep�iirmg (describe): .__-__•_-____ . __.-_ '* --•--- ------- -------------- -- --- " --------,- ----------------- ------------------------------- --------- ------------------------------ ------------------ ---------!t--------------------------------------------------------------------------i---------------------------------------- ----- --i I hereby certify that I have prepared this application and that the work will be donee in accordance th San Joaquin County ordinances, S flaws, nd rules arrd regulatio�ts'oft a San Joaquin Local HealtDis nc . ry v �r �'r�onfractor) (Signed) J (Title] ------------------------ --- --- -- --------- By--------------'------ --- (Plot plan, showing size of lot, locattan-_ofYsystem m„relation#ozw Isjuildingst,e .,,can,.be,placed.,on._rerrerse si e]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ._ ----. -. d' -------------- - --------------------------------------- DATE-- a 4 ��' ------------------------- REVIEWED BY-------------------------- ----------------------- ----------------------------------------------------------------- - ------. DATE---------------------- ------------------ -------------- BUILDING PERMIT ISSUED------------------------------ ----------- -----------------------------------------------• ------ DATE-------------------------- Alterations and/or recommendations:--------------------- -------- --------------------------------------------------- ---------------------- ----- -------------- ---- ---_----------- ---------------------- --------- FINAL INSPECTION BY:- .-_.'°-� ...........---------............ Date------- � / ----------- ------------------_--------- _ -�---� -- -- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ma=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street ' Stockton,California Lodi,California Manteca,California Tracy,Callfotala—" e - � F.P.CC.