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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica4-ion is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Orcliqqpeq No 549 JOB ADDRESS AND LOC 10 ---M-6-7jow- ...... Fit -------------------- -- -- - ------------ ----------------- ------- Owner's hen ----------------------- A ----------------- Address------- _2------------------ g-6 ------ -------- --------------------------------I--------------------------------------------------------------------- - -------------------- -- Contractor's Name------ -------------- ------- - ------------------------------------------------------------- Phone----------------------------------- ------------------------- Installation will serve: 1;�e�iclencX Apartment House 0 Commercial E] Trailer Court ❑ Motel L] Other El El Number of living units: I Number of bedrooms ----/_ Number of baths ___/... Lot size ------ --------------------------- Water Supply: Public system ❑El Community system [I Private x Depth to Wafer Table Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam E] Clay [] Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes No 17-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank I or cesspool permitted if pu,b"wer is available within 200 feet.) _j S�._..r Twell__...._---.-____ f epic a_nk Disfarici'f from � ati Mi-en - --- - - - -------------- Distanoe .rom foundation__. ---------- 47— Si No. of compartments.._....._e---------- Liquid depth_..__.---. -- ----- --Capacity-- Y --- Disposal Field: Distance from nearest well-_;k Distance from fours 1!0 ---------Distance to nearest lot line-,---------- Number of lines-----.--____I_________________ Length of each line---.- !!._.Width of trench-------eg- -- ------------ Type of filter material--- Depth of filter material___----/..IT Total length-_-_______--4g-lp------------------ Seepage Pit; Distance to nearest well....------------------Distance from foundation_.______...._._.--- Distance to nearest lot line----------------- El Number of pits.____. ..Lining rnaterial---------:----------_Size: Diameter_______________________Depth-..----.-_-----_______-----___.__ Cesspool: epth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation______..._..-__.._. Lining material---__.__....-_-.-.-.___-.__-__.____-_. ❑. T_. ... Size: D r aterial------------------------------------- Size:.Diamefer-----I Depth------------------------------------------- -----Liquid Capacity------------- --------------- Privy- Distance from nearest well-------------------------------------------------Distance from nearest building._.__.--_-_________--____._-_..___------- ❑ uiHing__------------------------------------ F-1 Distance to nearest lot line.._______._______.._ -------- ----------------------- &- -R--e--m---o--d--e--l-i-n--g----a--n--d--Z--o--r-- repairing (-describe): ---- ------------- -------- --- - ----- --------- ---- -- ------ - - - -- - ----- - ------ ----------- --------- ----------V--------------------- ? n -- - -If. ---- - ----- --------------- ------------------------------------------------- -------------------------- - -- ---------- - - I hereby certify that I ha e prepare� this application and th +he w done in accordance with San Joaquin County ordinances, State laws, and es and re I f the San Joa in Local a District. _Pu ations o (Signed) --_ -------=--------- --_ ---------------- -------- --- ---- ----- --- - --------;------------------------------------------------(Owner and/or Contractor) -- ------------------ By:----------------------------------------------_- ------- 77. ---- ------------[Title)--------------------------------------------------- ------- p location 'y' i- ----- G-) r7 (Plot Ian, showing size of lot i i to dildiri4i efc., can 6e place d on verse s�id FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- DATE----------------------------- ---------------- REVIEWEDBY--------------------------------------------- --------------- --- ------- ------------- DATE---------- . BUILDING PERMIT ISSUED------------• ------------------------- ------- DATE----------2__ Alterations and/or recommendations: ................ ...................... ---------- --------------------------------•----------------------------•--•--- --------------------------- - ---------------------------------------------- ---------------------------------------/-----------------------------------I------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- - ------------------------------------------------------------------------------------- -------------------------------------------------- ----------------------------------------- ------- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- -------- --- ------------------------------------------------- ------------------------ ------------------------------ FINAL INSPECTION BY------------ ----- --4-------- --- - ----- _ ---------- Date.---- 4/. ------------------- ---------------------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 110;South AmeHaan Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street StockS11- .i. � Lodi, California Manteca, California ton, Cal, �1-ia Tracy, California E5-9 145446-TW.nD- >*