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–Y Permit Permit No. __�6_- -g---- APPLICATION FOR SANITATION PERMIT 0-lkl, �� (Complete in Duplicate) Date Issued Application is hereby made to the San 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. 549. - JOB ADDRESS AND LOCATION------ - �_� �f,(�.`7h_---��-i9�-�1fn�11 -----:--�Pr��1�------------------------------------------------•------------ �11� ` Phone-----`-----9 — Owner's Name-------------------------------------- 7. - ----------- Address__--------------------------------•------------- ?��'_��---�'"_r�_�c{_'__�:��------- ---------------------------------------------------------•..------------------------------ Contractor's Name------------- --- Qa�-"t-_S,c ;----- ----------------------------------- Phone. e C] Motel ❑ Other ❑ Installation will serve: ResidenceApartment House ❑ Commercial [:] Trailer Court 2`c1 f Number of baths __Y Lot size _____ _ Number of living units: _Number of bedrooms _ �q"" Water Supply: Public system ❑ Community system ❑ Private,�Depth to Water Table ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan'❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPEJO INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2D0 feet.) eptic Tan : ` Distance from nearest well ___--__------Distance from foundation_____-_-----------.Material------------------------------------------------ 1 Li uid de th-- ----Capacity-- -�. No. of compartments Feld: N Distance from nearest well------------------ from foundation_,_-_____---_______Distance to nearest lot line_________-_.___. j �Fi•r'7 Number of lines-----------------------------------Length of each line-------------------------------Width of trench---------------------------------- E Type of filter material------------------/-- -- -Depth of filter material----------------�--Total length--------------------,- -- --� - .� Seepage Pit: �j� Distance to nearest well-____/___ _-_Distant fr ifoundation__ -- ----Distance to nearest lot line—.13 6f Linin Size: Diameter �� Depth-j0__1'--A---A- , Number of pits-"__----� g material- -_____ -_ Cesspooi: . ' Distance from nearest well-----------------Distance from foundation--------------------Lining material_____-__________-__-----------"-1s. ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------:-----------------g Privy: Distance from nearest well--------------------------------- -- ______---__Distance from nearest-building----------------------------------------- Distance to nearest of ine----------------------------------- --- - ----------------------------- Remodeling and/or repairing (describe)-------------------- -- ----------------- P ___________-..___________________"__-..____________-_-_____________. ------------------------------------------------------------------------------------------------ -------------------------------------------------------- __________________________________________________________________________________________________________________________________________________________ I hereby certify that I have repared this a plicatron�and that the work will be done in accordance with San Joaquin County ordinan es, St'te law and rules d regulatio rs of therSan Joaqui L al Health District. Si ned__ v r Contractor) --6w--------- ---- — ----------------- — (�° { g ) - -- - - --------- r 4 - -- --- --------- ----------------------------------------- --------------------- _ (Title)_F0-514 Ir1'l-n� . y•-:. s,,..-------- ---- s- - -- --- �— .. . (plot p ori, show n�size-of lot, location of sy em in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - - -----=0,--4------------------------- DATE'jr DATE-------f-----------•----------------------•------------ REVIEWED BY---------------------------- - DATE---------- BUILDING PERMIT ISSUED-------------------------------- ------------•------- ------------- Alterations and/or recommendations:--------------------------------------------- ----- -----------------•-------------------------------------------- ------------------- 1 --------------------------------------------------------------------------------- ----------------- - -------------- ---- -------I------------------------------------------------- INSPECTION BY:---------- - /�--`- Date - FINAL INSP �r r V SAN JOAQUIN LOCAL HEALTH DISTRICT .132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Manteca, California Tracy, California Stockton, California Lodi, California ES--9-2M 8-51 Revised W-2100