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FOR OFFICE USE: ------ -------- -- Permit No. k d jj - L APPLICATION FOR SANITATION PERMIT _ (Complete in Duplicate) d Date Issued ------------:�r•{°•/ This Permit Expires 1 Year From Date Issued i9c A lication ishereby made to the San Joaquin Locale Nealfh D s�rict�for a permit #o cons#ructYand install the work herein describe . - This application is made in-compliarice witl County Ordiriance-No.�549. '" ---------------- JOB ADDRESS AND LOC TION_--___ t +��¢S - ---------- Phone-------------------------------•---- Owner's Name--------- --=- -�a�+��-..--•-- - -L� -- --- # -------••------------------- ---------- Address----------------------- � '_ �..-t � .. Nr� S t ------ - ---- - ------•---- t_---------•----•-------------•-----.----- Phone--------.....-----••----•--•-----.. -}�r, _x ---------------- Contractor s Name__________________ _F_ Motel Other ❑ Installation will serve: 'Residence;k Apartment House ❑ Commercial ❑ Trailer Court ❑ Z I l -" ___e ---, .,1.7------------------ Number of living units: } -- Number of:bedrooms _-oZ Number of baths _.. .._: Lot size ____ Water Supply: Public system fiQCommuty sym"'❑ Private ❑ Depth;to Water Table -------- ft. Gravel Sand Loam ❑: Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand 0" ❑ Y i ! _ i FHA/VA: Yes ❑ No [] Previous Application Made: (if yes;date__-_..-__A ----} No ❑.� New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ., t E ( P from nearest well � c is a ailable within t feet. No se tic.tank stanGess ;oalpermitted.e-iwell s .from fpundation_____l+f�_____---.Ma er ial__ OM� T - ------------ P Septic Tank: a ./ �Y _Capacity J�4 No. of compartments____ Sizer: __A-. /�- ::Liquid depth p Y t • l'� Zj ---------Distance to nearest lot line------+ -_. io Disposal of,lines----- ..- �--- 9j �r �f Width of trench--- r osal Fieid: Distance from nearest well.-.. �--- De to}�of reach line--- Number al__.___ _-.__-_-__.Total length__.- - - th gf filter mate ffJ - Type of filter material________ F Q Seepage Pit: Distance to nearest'well__________________'__-Di t-ance from foundation....................Distance to near est lot line__-_____..-___.._ Number of.pits-1-------------------Lining material•----------------------Size: Diameter- Depth a t ❑ mafer ,� I Cesspool: Distance from nearest well_______________-Distance fromfoundation-------------------ILIin`ng Ca otic gals. -----------------------------------Depth-', _-- ---- --- q Capacity---- - ❑ Size: Diameter. - `______-__Distance from nearest building___-_---. Privy: Distance from nearest well________________________ _ i Distance to nearest lot line_-_-------------- ---------------- °-------- ----- } E ----------------------------•------------- ` +`A Remodeling and/or repairing (describe:___---------------- ' ----------- } -----------=----------•--------- T ___________________ ____________________________________________________________ ___________________________-----------------.-_______--__--------- ------------ -- -__-_-_ -__________--_______-_-_--__-- _ -----------------------_ ____________________________________________________________________________________________________________________________________ I hereby certify that I have prepared this application'and that the work will be done in accordance with San Joaquin aun y ordinances. State laws, and rules an d regulations of the San Joaquin'Local Health District. i µ d Owner nd or Contractor) ------------------------------------ l- -------------------- (Signed)-t- am-40-4 �t - - ----------------(Title)------- ----- ---- --------------------- By:-- --------- _ - - (Plot plan, showing 'l sire of lot, of system in relation to wells, buildings etc., can be placed on reverse si e). { t FOR DEPARTMENT USE ONLY tDATE------------------------------------------------------------ APPLICATION ACCEPTED BY----------------------- ----- - --- DATE_-----------•---•---•---•----------------------•------------ -------------------------- REVIEWED BY t... - F ----- DATE----------------------------------------------------------- BUIL ING PERMIT ISSUED------------------------------- ...................--=----.... Alt ation and/or recommendations--=-=- ----------------------------- -----------•-- ` J c � ' ---_--�-- ---- -- •------------- ' �-"------•�. � w cam- - -------- ------------- - = ------------------- --------- - .__-� .......... ---- .. z •-- -- -- --------- Date---------- S --- ---- le:9-zel, --- _ ------------------------------ FINAL INSPECTION BY:--------------- ---- 7 SAK JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 130 South American Street 300 West Oak Street Lodi,California Manteca,California Tracy,California Stockton,California E9-9 REVISED C-50 F.P.CD.2M 6-6P