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FOR OFFICE USE: .'. p In d.. ? Permit No. g ---------- - -ydf APPLICATION FOR SANITATION PERUIT (Complete in Duplicate) Date Issued -----------------G-- b made to the $ This Permit Expires 1 Year From Date Issue Application is hereby an Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544. .1449. fie -!;-10----- •---------------------•--------------------------------- JOB ADDRESS AND OCATION-------- ------ --- ----- ----- Ph � 4�� . one------------------------------------ -------Owner s Name- = ------4---w •----- ..-- A rr Address------ 6 ..._--_. .. r , - e. _ «� Commercial Trailer Court Phone Contractors Na ------ - -- - i r r# ❑ Mote ❑ Other ❑ Installation will serve: Residence Apartment House ❑ C t,❑ --- Lot size, oq-x-I-�01--------------------------- Number of Living units: -1--- Number of bedrooms . .- Number of .baths _ _ 10, fte . Water Supply: Public system Community system ❑ Private E] Depth to Water Table &-6 ft. Character of soil +o a depth of 3 feet: Sand ❑ Gravel [] 5 dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Lid" 17ardpan ❑ 1 �� Previous Application Made: (if yes;date--------------------) No New Construction: Yes �l 1VQ ❑ FHA/VA: Yes ❑ No ] f i TYPE OF INSTALLATION AND SPECIFICATIONS: LL j (No septic tank or cesspool permittdd--if pulic'sewer is'available within 200 feet.), f �•�_"..___Distance from foundation. _ -Mat ri ! �•- ---------------_..- Septic' k: Distance from.nearest w I.... -__-- """` "" p . _ " `.Liquid depth----- ---.Capacity � "'C ------ -------Size------ - - --------- --� -- -------- No. of com artments_. - --- - I k t w Disposal Field: Distance from .6earest well.-'"-----.-Distance from foundation.l�_CX_:----------Distance to nearest lot line��-------------- �,►'" Number of lines------------ - =r--Length of each lire----------------------7-#---Width of trench----*' - -------------- +, f of filter material: ---1 ---Total length----- + .Type of filter ma - r S' -- Distance to nearest lot line.. .-Seeps Pit :- .Distance to nearest well-___""�`"---------Disfahce from'foundat n..._..- - it Dept h--_. - _ ----------- S -_ - _---..Lining material t�• 4--Size: Diameter_. ----- Number of pits-.----- _ _ Cesspool: Distance from, nearest well-".-......""_-_.Distance from foundation................."..Lining material _...___...-""...___"...__._..-.___._-. ` i ----------- -------- gals,Luid Ca acitY Size: Diameter-- ------- ----------- pth---------- --- --- - t fine...__-_-------------------------------------- Distance from nearest building---------------------------------------- ' Priv --------- ------- ----=--- ----------- ,� . Distance from.nearest well--_-__-- -----------^---------- -------"_- ❑ = Distance to nearest lot I '?------- _ Remodeling and/or re aErin describe ----------------- ---------------------r---------- - fJ '' ----- ---------------- ( ---------------------------------------w---•-------------------------------- --------------------------------------- ------------------------------ 1 1 hereby certify the+ I have prepared this a plic lion and that the work will be done in accordance with San Joaquin County ordinances, State laws, an� ule 'and regulatio o he San oaquin Local Health District.- ( caner and/or Contractor)--'l - ---------- ----- O (Signed)_ -------- -----------------` - -- -------------------------------------------(Title)--------------------------------------- - 5 (plot'plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B : e r, DATE-.-- �2111 --- -------- ----------------- Y -------- --------- - �/ t. DATE----- ---------- ----------------------------------------- BUILDENG PERMIT ISSUED--••---- -•--------- --• ---------------------------------I BY--------------------------------- ------ ------------------- --------- --•--•M PATE-- --------------------------------------- ------------- Alterations and/or recommendations:"--------------------------- - -------------------•-------------- --------------- -------------- -- ----------------- --------- ---------------------------------------------------- ------- -------------- 1 r -"--------- i Date ----- -/------ -'" FINAL INSPECTION BY.--- - --------- ------------------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co.