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- 4_4 (J OAPPLICATION FOR SANITATION PERMIT Permit No. ----7_73. (Complete in Duplicate) Date Issued ---- ------------ Applica+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 Ordinan p No. 549. AL-1 JOB ADDRESS AND L5��N----- -----------------------------County 'Drcl'nan No ------ - ---- . .... -------- ... . --------------I ----- ...... ..... om Owner's Name------- ----------- --- ----------- - - -------------------------------------- Phone----------- .......... --------------I--------------- ---- ---- ---- - -- ---------------------------------------------------------------------------------------- Address------------- _7 45---------- Contractor's Name------------_---------- - -------- .... ----- ---------------------------------------------- Phone----------------------------------- Apartmen ouse [] Commercia E] Trailer Court ❑ Mot Installation will serve: Residence E] Other E] Number of living units: ---t- Number of bedrooms -------f Number of baths Lot size ------- ---- ------------------ -------- ------- Water Supply: Public system E] Community system F1 Priva teX Depth to Water Table ff. Character of soil to a depth of 3 feet- Sand E] Gravel Ej Sad Loam Ej Clay Loam [] Clay E] Adobe C] Hardpan 0 Previous Application Made: Yes 0 No V1_New Construction: Yes V No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Seniicb Tank: Distance from nearest well--516--bist'_Distant Vfr�f d * ---- ----------Mat r - - ------ 0--j?pLinquid depth.-------- --------. apaci y-- ------------------- No. of compartments------* Size .... .. C _� _01d��6 DIXSPI Field- Distance from nearest well t__ ____.___D1stanc.e from foundation---3_0......Distance to t lot I' - C7 neares o i e --------- Number of lines___.__:._ ----------- -Length of each line--------V.-A9.......T,!_.�Viclth of trench ?..e- ---- - ------------- Type of filter material-4 1_4*�_Depfh of filter material------1_1----f-..Total length-.--, ________________________ Seepage Pit: Distance to nearest well----------------------Distance from founclaf n--------------------Distance to nearest lot line----------------- P 0 Number of pits---------------------Lining material------------- ------ .-Size:.Diameter----------------------.Depth------------ -------------------- Cesspool: Distance from nearest well-----------------Distance froefounclation..-,------- Lining material______---_.._____.__.___-___._____- - --- - ---------------rDepth= s.-- �;--:=:--:_x - -- --- -------L�iquicljCApAci_y __�,_g�ds --r-- --- —---- 7 Privy: Distance from nearest well--------------- ----------- -------------------..Distance from nearest building._-.______-___.-_-----_-____------_____._. ❑ Distance uilding------------------------------------------ Distanceto nearest.lot line--- -------------------------- ------------------------------------ -------------------------------------------------------------------------- e e,7 ---- --_------------------------ ......... Remodeling and/or repairing {clescrib . . ....... --------------- ---------- V (7'1* W.. ----- ------- -- -------- ------- ------ - ----------------- _%14 ---* -------------------------- ------------------------------ --------- ----------;----------------- ---------------------------------------- ------------------ ------------------------------------------------------------------------------------------------------- ----------------------- -E-1 --------------------- ------ -----120'1 _7.75�!A I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances, State I ws, and rules and re ulaflons of the San Joaquin Local Health District. 01-- 0 (Signed)&.,, --- -------------------------------------_--------------------------------(Owner and/or Contractor) By:------------------------------- ------------------------------------------------------------------------------------------------------(Title)------------------------------- ( ---------------- ---------------- i (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 BY-------- -------- - --------- ----- --- ---- DATE DATE----------------- ---s----- Z--------------- REVIEWEDBY---------------------------------------------- --------- - ------------------- DATE------4,__4-_4----------------------------------------- ------------------------------------------------------------- BUILDING PERMIT ISSUED --fe -_ Alterationsand/or recommendations:-------__------- ------------------------- - ---------------------------I--------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------__.........-11-------- ---------------------------------------------------- ------------------------------ ----------------------------------------I-------------------------------------- --------------------------------------------------------- I -------- -------- .... ......t A---- ----------------�_c--------------------------------------------- ---------------------------------------------------------------------------------- ------4;�_ --- ---- ------------- --------------------------------- ------ ----------------------------------------------------- --------- ------- ------------ ----------------------- -------------------- FINAL INSPECTION BY:---.------------------ -------------------------- ---------- Date------ 21. _A?1 --- ---------------------- -- ---- -------- ---- FINAL LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca. California Tracy, California ES-9-21A 145446 A7WC10D 12-54