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"D -APPLICATION FOR SANITATION PERMIT Permit No. V� (Complete in Duplicate] l F T Date Issued --------'- e San Joaquin Local H'ealtli District for a permit to construct and install the Application is hereby made to thwork herein described. Thin application is made in compliance with County Ordinance No. 549. ? i Ea ----------------------------------------- JOB ADDRESS AND LOC$,TIONa -- ------ Phone. = = �_ ---- •- ------------------------------------- r ----------------------- ----------- h. Owners Name___. - Address-------------• .- r --------------- ' ------------ ------------------ Contractor's ---==_-=----•=-Phone---=------------- ------=---------- Contractor's Name =- _ ----- = = = = = ., --- + Commercial Trall r Court ❑. Motel ❑ Other Installation will serve: Residence Apartment House ❑ f ; Nuritibet of living units: ` --.-- Number of bedrooms _ ___= Number "baths -_ Lot size __.__ ____ ___ - Priv'ate" Depth`to`Water Table Water,Supply: Public'systerfi-❑' l ommuriity'system'❑` Adobe re Hardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam © Clay Loam ❑ Clay ❑ ❑ 1 Previous Application Made: .Yes ❑� No v New Construction: Yes W101"No E] FHA/VA: Yes ❑ No [V TYPE OF INSTALLATION AND SPECIFICATIONS: r (No soptic tank or'cesspool.permitted if publicsewer is available within 200 feetr] �s , ry' " Dista c fr foLM anon . - •-- Material---- + ----- Septic Tank: Distance from nearest well__ ___. ? ` k + Size_ .. Liquid eNh----' --- iCapautY 1J No. of compartments____________________p-_ _ 6- -------- �., { �y Distance to nearest lot line_ `--- -- Dispasal°Field: Distance,from nearest well__ 5� ___--Distance from foun do Aoj Width of ti•ench________-__�'---�r;.-------- -----------Len th of each lini -. Number of lines__ g _ --- - -.-_.. —- 94 ---- Type of filter mate6gl _ ti Depth of filter snateriaL_____ -_ Total length ___. ,f - f ,,_��,,,� �":_-,�_.D stent o nearest lat I�ne_.____..__ } ! Seeps Pit:' Distance to nearest w l!'__�_� -__ --'D�stancerom au dation _-. � E De th 4? •------------------- Linin material__"'-----Size: Diameter:_ Number of pits ------ g s ----------- r Cesspool: Distance from nearest well___ __Distance from foundation------------ - Liquid Capacity{______'-___________-_____gals.:' Depth------------------------------ ---- --=---------- ❑ Sizer Diameter'---------------------- 3 Distance from nearest weH----------- =- -- Distance from nearest building-'-------------------^-------------------- Privy: -------------------------- ----- -------- --- --------------------- -------------------- --------- ---- - Distance to nearest lot line.___..__:-_-=`------- -,. T �R a ` Remodeling and/or repairing (describe):------------------------- -- \-] s ----•------------------•------------ -------_------------ lm--- •---------------- -------------- ---------------------------------------- ------------- ---- - ------------�--------------------------------- - -------------- -------------------- ------------------------------------------- ---------------•--------------------------------•:------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, St to laws, and rules and regulations of the San"Joaquin Local Health District. S f71 --------------------- (Owner and/or Contractor) I (Signed)------- - 9 .- -•--•-(Title)--------------------------------------------------------------- - ----------------------------------------- y (Plot plan, showin size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------ - ---------------------- DATE-5- ------- --------------------------------------- Niru REVIEWED BY ; -------- --------------------------------- DATE __-_----- 1 ---•------ ------------------ DATE.--- i---------------•-------------------- ----------•---- , BUILDING PERMIT ISSUED -------------- -- Alterations and/or recommendations:-------,------------------- - ---------- ---------------••--- - - - ------ ' ` ' '' --'----------�4?G �= ��C1J x�C2y.�__i.� �l�� rx'G:r S�St1�!f�5. rctL.�71 l -1-=&------------------- ----------- ------------- ��/41 ' exeu..--�' _D--f----------f-� i12.tom! �+a• � � ------------- ------------- k I-1Ay � - c'G.caS f T� ..___.----•----•--------------• Y Date-_.._. _ a ±E.,�.�.-- ----------------- FINAL INSPECTION BY:, �__�r�x --- ___'_ --- " 4 ..1 ad -�ticl�.ci SAN JQAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 13o South American Street Manteca, California Tracy, California Stockton, California Lodi, California f ES-9-2K4 , Revised 1.57 F-P.CO.