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Perm-it No. <br /> APPLICATION FOR SANITATION PERMIT Data issued ---7/- - <br /> (complete in Duplicatel <br /> permit to construct and 'install the work bere'sn described. <br /> a San Joaquin Lo ca� Health District for a p "V, cor4pr�,4 'XO <br /> _e N o. 549. <br /> Application is hereby made to the e with County Ordinance -IV-------- <br /> This application is made in comp lianc <br /> JOB ADDRESS AND LOCATION---------- ------ --------------- Phone----•------------------------------- <br /> ------------------------ <br /> ------------------------------------------- <br /> -------- ---- <br /> Owner's Name------------ ------------ --------------------------------------------------------- <br /> -- ---- ----------------- Phone----------------------------------- <br /> Address------- -------- .........704•-------------------1 0�- -------------- <br /> ----------------------------------------------------- - V [] Motel [] Other 0 <br /> Contractor's Name--- i Commercial [] Trailer Court r Residence Apartment House El Commerc ------------ <br /> Installation will serve: edroA <br /> -_ Number of b ms Number of baths --A--- Lot Size -------- <br /> Number of living units: ------ I jh +' Water Table <br /> Private Dep 0 <br /> Supply- Public system El Community system Lj Clay Loam [I C14 C] AdobejN Hardpan 0 `j) <br /> Wafer D .Sandy Loam 0 <br /> Character of soil to a depth of 3 feet: Sand [] Gravel <br /> C I No <br /> New onsfruction: Yes <br /> L Previous Application Made: Yes FPECIFICATIONS: in 200 feet.) <br /> TYPE OF INSTALLATION AND S I ?,Wic�sewer is available with! uuotd--- -------------- <br /> (No Septic fa"nk`dr cefssP_06I_0_eyn_'_".+e`d iffoundation-------0---- Materi-a-L.-,---- ----- -- ------ a <br /> e from - pp '1_1-----------Capacity ,r___,p, <br /> :1 well-. Distaricde <br /> Septic Distance from nearest X-5--X---I.....Liquid <br /> Tank: -of compartmerifs----------- ation----- ....Distance to nearest lot line--_-.- <br /> of trench------------- <br /> f <br /> rench-------- --------- <br /> sal Field: Distance from nearest well------S_ i4ist nce from found Width <br /> Disposal -Lerifth of-each line-------- f----------Total length---------- z <br /> Number of lines-.--___-_- ---- ----- ---- ------ <br /> pth of filter material- -------- <br /> or material------J_X�- ----------Do , nearest lot 1i <br /> Type T filter 0 foundation--------------------Distance to <br /> I Distance from, <br /> Distance to nearest welt----------------- Diameter--- ----•---- - -.____.Depfh-------------------- ---- ----- <br /> Seepage Pit* a erilal--------------------- Size <br /> El INL�mber of pits---------------- Lining rice from fo��dafion`!��-------------Lining I _ <br /> -[Dista ity--------- -------gals,. <br /> Distance from nearest we0---------------- <br /> F--.-----Liquid Capac <br /> ga <br /> materia------------- <br /> Cesspool::. -1,De <br /> --- ---- pth------------------------------------- ------- <br /> Size: Diameter--------------------- ------ it� <br /> %_ Distance from nearest bu;lding---------------------------------------- <br /> ------------------------- ------------------------------------__-- ------------- <br /> Distance from nearest well ------------- -------------- ------- <br /> Privy: _G_ --------------------- <br /> Distance to nearest t line--_--------- �i -, <br /> ----------- ----------------------------------------n------------- <br /> ------------------- <br /> ---------------------------------------------------------------------- ---------- <br /> escriu -------------- <br /> V <br /> Remodeling and/ror repairing (d ------------------------ .0------------------------- --- <br /> Ii -------------------------------------------------------------------- ------------- ------------------------------ ,_i <br /> -------------------------------- ------ ----------------------------------- ------------- k —---------------------- <br /> r --------------V_ ---------------- <br /> ---------sl --------------- -------------------------- <br /> ------------ -- ------------------ ----- ---- ;jifl�S " Joaquin County <br /> -----------­--------- ------- <br /> 1----------------------------------------------------------------------- 'in accordance an <br /> --------- ion and that The work will be (lone <br /> 4. <br /> ... ......... Health District.have prepared this applicati <br /> I hereby certify that I aN <br /> -ordinances, State laws+ and rules and regulations of the San Joaquin Local --------(Owner and/or Contractor) <br /> --------------- ---------- .............. <br /> -- - - -- ------- ----------- -------- -------------------------- [Title)------------------------------------------ ------------------- <br /> - <br /> (Signed)-----/T_ ------8� ---------------------------------------------------------- reverse side). <br /> ------------- bi� placed on <br /> ------------ etc., can e <br /> in rela <br /> _t_� s7y,�e <br /> ------------------------- <br /> 1. By:---------- 1 size of lot. location (of syste in relation to wells, buildings, <br /> owingi ............. <br /> (plot plan. sh . ...... - <br /> USE ONLY <br /> 1:01 DEPARTMENT <br /> DATE---- <br /> By----- --------­--------- -------- DATE-------------- ---- <br /> AC <br /> APPLICATION ...... --------------------------------- ---------------- -- <br /> I -------------------- ----------- DATE------------------------------- <br /> BY----------------- ------------ --------------------------- --------- - ---------- <br /> PERMITISSUED----------------------- ------------------------------ ------ -- ----------------•--------•----------- -------- ------- --------- <br /> Alterations and/or recommendations:-------------------------------t ----------4nA-r4------- -------- <br /> ---------------------- --------------------------- ------ <br /> -----------------------------------------I-. --- ------­-------------------- ­. ------ <br /> ------------------------------- ----------------------- -------- ----- ------ ------------------------------------------------------------- -------- --------------------- <br /> ---- - <br /> -------- - -- ---------- <br /> -------------------------- -------------------------------------------------------- <br /> 6U <br /> Date.._.-_.ff ------------------- <br /> ---------------- <br /> FINAL INSPECTION BY:------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 914 North "C" Street <br /> 132,Sycamore Street Tracy, California <br /> 300 West Oak Street <br /> 130 South American Street 'Manteca. California <br /> Lodi, California <br /> Stockton, California <br /> rr-9-2M 1()-52 Revised W-2100 <br />