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'r—ET �•�� FOR OFFILUS�E:�- C.- Permit No.APPLICATION FOR SAKITATION PERMIT� �. -------- (Complete in Quplicata) Date Issued el--- ----- This Permit Ex ires 1 Year From Date ssue Application is hereby made'to the San Joaquin notal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Q/!� , 3 -- -- -- -------- --- r� 1J G JOB ADDRESS AND LOCATION- 1 n Phone-------------------- Owner's Name----------- 4------ -------•---------------- G f Address.----•---•--•------ � ._ ` Phone_ 7------- -------------- ---- r• -'----- - - .,,��j----'--•�/f��F�----- -'------ -- Motel , Other [�- _ Contractors Name..-_-----_. - '' % Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ _.....❑ ------- `�--- ,�. Lot size -' f � Number of living units: __/,. Number of bedrooms ..___ Number of baths:. Community s stem ❑ Private �ZDepth•to Water Table G'�- ft. i Water Supply: Public system F1y y Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Character of sail to a depth of 3 fee}: Sand ❑ Gravel ❑ Sandy Loam ❑ Y I No HA/VA: Yes ❑ No [� Previous Application Made: (If yes date--------------------) No D' New Construction: Yes ❑ �~ TYPE OF INSTALLATION AND SPECIFICATIONS:, f t 0 feet.) (No septic tank or cesspool permitted if.pubiic sewer is available within 20 Septic Tank: Distance from nearest well-2115-49-----Distance from founndafiion_. - Material- i � 'A^ i� No. of tom artments...- Size. `' Liquid deptCapac3tY.3G .¢O-_---.....Distance to nearest lot'line................. Disposal Field: Distance from nearest well-_\-7 .-Distance from foundation.... Widfih of trench.. -,��`-- Number ,of Lines- '2-: - - ------Length of each line._ _ = rt Type of fltes material_ ------Depth of filter material. ------Y----dotal length_.._-------- ---------------- ! i z-w r 1 See a Pit: Distance to nearest well_-Z.2 -- - Distances%fr . .:foundation -•------Distance to nearest lot line- ---- f. p q� . ._ . De to .-` Number of pits.---��---' -_--Lining material -�- Size: Diameter-- -- p - -j...,. 1— ,,..._ - wf;..., ------------------------------------- 11 _ __ _________ mc Cesspool: Distance from nearest`well--_---------. Distance from foundation._-.___.- L nti d Ca aril gals. ❑ Size: Diameter----_--------------------- .::--Depth q P tY' 4Distance from nearest building--------------------- Privy: Distance from nearest well----------T------------ ---- ---- ! ❑ I Distance to nearest lot lire.---- -I-----------7- `--=-- "}' 5 /- " Remodeling and/or reparr�ng (describe):-- — --------- �. . ---------•------- ------• -------------------------------------- -------- -------------------------------------- ------------------------------ ------ ----- --- ----------- -------------------------------------------------------------- =---- ----__ - ----- 1 hereb certif that I have prepared this application and that the w.rk will be done in accordance with San Joaquin County Y Y ordinances, State laws, and rules and regulations :of the.SanJoaquin Loyal Health District. er an /or Contractor (Signed) --' --.� _(Title}-------- By -----'- -- - f BY= '=�f •_ ..--r" -------•--------------------- (Plot plan, showing size o lot, location of tem in�lati'n to wells,=-_buildings, etc., can be placed on reverse side}. i FOR DEPARTMENT USE ONLY li " - --- DATE-------�� ------ ------- - -------------------- APPLICATION' ACCEPTED BY-_._...-- , ---- --------- - DA --------------------------- recommendations..� / DATE ( >� REVIEWED - - ' , BUILDING PERMIT ISSUED--------------- --%'y////�---- -----'- ------ Alterations and/or -------------------------- ------------- ----------------' ........ ------------------------- ---------- -- / FINAL INSPECTION BY:--'---/��-�� ----------- -'------ -'--------- ---- Date-------1-�/01:5 ----- -------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 west Oak Street 124 Sycamore Streei' 205 west 9th Street 1601 E.Naselton Ave. Tracy,California i, Stockton,CaliFarnia Lodi,California r Manteca,California F\ F.P.CQ.