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APPLICATION FOR SANITATION PERMIT Permit No. _6J11---2).;_,Z (Complete in Duplicate) Date Issued Irlica4-ion is hereby made to the San 1?a Aa per.m it to constru nd install the work herein d6icribed. 'spapp ,,� in Local Health District fo T application is made in compliance County Ordinance No. 5 9f JOBADDRESS VOC TION__ ----- ---------- ------- ----- ------------- -------- ------ _-1 - ------------I--- ---- --- -- -- Owner's Na --- ---------- --- ----------- Phon N, Address --- -------------------- ---------------- -------------------- -------------------------------------e�_ Contractor's Name----- I�I Phone--,-7.... Installation will serve: Residence E] Apartment House 0 Commercial Trailer Co-urt C3 Motel 0 Other 0 Number of living units:,__ Number of bedrooms _44 _ Number of ba hs I--- Lot size ------------------------------ Water Supply: Public system Community system 0 Private 0 Depthto Water Tabi ft. Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam 0;j1 Clay Loam 0 Clay [] Adobe Hardpan 0 jI Previous Application Made Yes 0 N OXNew Construction: YAeEI"^ N 0 TYPE OF INSTALLATION AND SPECIFICATIONS: !11 (No septic tank or cesspool permitted if public sewer is available within.200 feet.) Distance from nearest --- ------------------ Septic Tank: arest well---A�_Disfance from fo-undalion--—-------------Material--- No. of compartmerifs-_9--- ---------------sieeadepth_P ' ?---------Capaci. ..... 41---/-/�p _y L_A_ Disposal lield: Distance from nea f we I------------------Distance from foundation—X----I--------Distance to nearest lot line_________________f Number of lines_____________-_____._____r? ----Length of each line---11--- ---,----,Width of trench_._______ _d 61 2. ___------- Type of filter nnaferiaj,,,'0_1'-.�._ - ------Depth of filter material-----------------------Total length-------------- 0 Se3eopae it: Distance to.nearest w6------4--� -----Distance,,*Om f da.tion----/��---------Distance to 'nearest lot line �1. - --- -------- :i a S ze: Diameter --------------------- Nu�nber of rn pi+s.--/---------------Lining mater di- ---Depth-.-- Cesspool: Distance from nearest well-----------------Distance from foundkionr-----------------Lining material_____._--_-_--- -------------------- F1 Size: Diameter----------------------------- ----------Depth--------------------__0 -------------- ----------Liquid Capacity--------------•-------------gals. Distance from nearest Deli_____________________ 11' Privy- -------------Di.slance from nearest building--�-------------------------------------- El Distance to nearest lof,line-------------- ------------------------------------ ----------------- ----------------------------------/------------------ Re, odelig and/..r repairing scri ....... 7 -------------- r to, - -------- ---- ---- - _/------------- ---- ----- -�4--------------------------------------------- Vil - ---------------- ------ -- �f ------------------------------- ----------- ------------------------------------------------------_--------------------------------I.............. ---------- --------------- ----------------------------------------------------- I hereby certify that-I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances la%�S,�ules and regulations of the San Joaquin Local H6alfh District. (Signed)........... --------------/ ---------------------------------------r----------------------------Iill N--------------------- _____(0 Owner and/or Contractor) --------Title ---------------------------- By._-----_------- -------------------------------------------------------------------- p cad on (Plot plan, showing sizeof lot, location of system in relation to wells, buildings- verse e ,Petc.. can be FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------------------------- _5L jo------- -------------- DATE------------/ _:7�_XX--------------------- REVIEWED BY------------------------------- ------- ------------------------------------------------------------------- ----------------- DATE-------------------- - -------------------------------------- BUILDINGPERMIT ISSUED---------:----------------------------------------------------- -------------------- --------------- DATE------------------------------------------------------------- Alterations and/or recommendations_______________________- -------------------------- ------------- --------••---------------------------------- ---- ------------ ------------------------------- -------------------------------------------------------------------------------- ----------------- IG -------------------------------------------------------------------------I----------------------------------------------------------------------------------------------------------------------------------------------------- ------------------I----------------------------------------------------------------------------------------------------I--------------------__-------- --------------------------------------------------------------- --------------------------------------------------------------I—---------------------�------------------------------------- --------------------------------------------------------------------------------------- /f 11 FINAL INSPECTION -BY--------------------- - - ------------ Date---------------- -------- --- -- --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore ,icaore Street 814 North "C" Street 4 Sfock+on, California Lodi, California Mantca . Revised W-2100 : . California Tracy, California ES-9-2M ;