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APPLICATION FOR SANITATION PERMIT Permit No.� __6_----- (Complete in Duplicate) Date Issued ___---- Applica4-ion 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. 9. JOB ADDRESS q OCATIOP4 22 AN )---------- ------------- --- ------------------------------------------------------------------------------------ m N --- ...... !.1------------------------------ ------------------------ --------------------------------- Phone------4Z i��------), Owner's Nam Addr ss . .............. ------------ ----------------- ------------------------------------------_--------------_- ----------------------------------------------------------------------- Contractor's Name----- ------------------------------------------------------------------- I----------------------------- Phone--- --------- Installation will serve: Residenc�' Apartment House E] Commercial Trailer Court E] Motel 0 Other E] Number of living units: _/---- Number of bedrooms •�-__ Number of baths _Z__ Lot size __-___-,i95 -Yz-// _________________________ Water Supply: Public system E] Community system E] PrivateX Depth to Water Table Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam E] Clay Loam F Clay (-] Adob q-k Hardpan 0 Previous Application Made: Yes E] No New Construction: Yes, No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we114_/-.rj0_"___Disfance from foundation______-6157 Ma.teriai-_Z�---- -------------------------------- No, of compartments--- Size_ Li quid de j pf h- Capacity------- Diwl Field: Distance from nearest we1,0?_,2_ _-Distance from foundation-------9----------Distance to nearest lot line_____.._. Number ine------ Number of lines-- _____:Length of each line------4.?0 ' Width of trench_____ ---------- - Z Type of filterDepth ------ of filter material-____ ----Total length_______ Seepa e ength-------Seepage Pit: Distance to nearest weld----,) J'----.-,"-D'tstance fr ,�Joyndation,_/42........Distance to nearest lot line____!_.______ 4:M. -----------Dept k------- ,2_,::�-------------- Number of pits---- -------- ------Ding aterial--- ....Size: Diameter______ _---__-__-_-�?_' Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material_____------------------___________-_. Size:-Diameter----------------- --------------------Depth--------------------------------------------------Liquid Capacity------------ - ------------ als. Privy: Distance from nearest well------------------------------------------------.-Distance from nearest building----------------------------------------- 01 Distance to.nearest,lot-line-------------------- --------- ---------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe);-- - -- ------- ------------------------------------------------------------------------------I--------------------------------------------------- Z I --------------------------------------- -------------------- ------------:---------- ---------•------•---------------------------------- ---------- -------------------------------------- ----------/ --- ----- -- ----------------------------------- y-- -------- - ------------------------------------ ------I---------------------------- ------------------------------------ --------------------------------------------------------------------------------------------------- I hereby certify fhaf-I have prepated this dppIi6ifi(;n-and 7faf the work will be done in accordance with San Joaquin County ordinances, Stat awe apd,rule and reg atio of fhe San Joaquin Local Health District. (Signed)- (Owner for] X, -- - ---- ------------------------------------------------------------------------------ ------- --- .. .................... -----------------------------------------------------(Titl - -- --------------------------------- By:--_---------- ----- ------- ?reverse side).O�J (Plot plan, showing size of lot, location of sysf e m in relation f o wells, buildings, etc., can be p a e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------------------------------OP005r�- -------------------------------------------- DATE- ------- REVIEWEDBY------------------------------------------:-------------------------------------------- ---------------------------------------- DATE BUILDING PERMIT ISSUED__---------_ k --------------------------------------------------------------- LDATE----------------------------------------------------------- -A---lt--e--r-a--t-i-o-I-n-s---a--n--d--/--o--r---r--e--co---m-m---e-ndaf-i-o--n--s-:-------------------------`:,-=--- :--: ---------------------------------------------------------------------------------.-.-.-..-.--.-.-.----------------------------------------------------- ------------------------------------ --N - ---------------------------------------------------- , A. 4 _; L-4- ---------------------------------------------------------------------------------------------------------------- •-----------•---------------------------------••---------------------------------•-----------..-. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- f ------------------------------------------ FINAL INSPECTION f4 BY----------------- ) ------------------------------=-------- Date------ ..—5.77�----- ------------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California S-9-2M