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APPLICATION FOR SANITATION PERMIT Permit No. ._�.-aJ--_z=4-- ' �tV (Complete in Duplicate) Date Issued """ pplica{ion.is hereby made to the San JoaquinLocal ntcaOrdenatnceDlNoG 549.a permit to construct and install the work herein described. This application is made in compliance with Y -------------------------•----------•-----•-------------------- JOB ADDRESYAN LOCATION__- -------------- ----_----- '------ 'i (l ------------------ ---------------- ----=---- `------------- Pone"----•---------- Owner s Nam ----- Address----••---- ------- -- ------------;------------------ •-------- ---- � one----------•_------•------ •-------------- Ph Contractor's Neme-- - ---------- Other ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Installation will serve: , esidence Ap - Lot size -"" ll©-----------------'------- Number of living units: ------ Number of bedrooms, --- Number of baths _�__-- De th to Water Table __.----- ft. Water Supply: Public system Community syste19 m ❑ Private ❑ p Character of soil.to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay El Adob� Hardpan ❑ Previous Application Made: Yes ❑ No;R�_ New Construction-. Yes ❑ Nov, TYPE OF INSTALLATION AND SPECIFICATIONS: �� , z . (No septic tank or cesspool permitted if public sewer is available wi4hin.200 feet. F •." " ------ ----- -------- Distance from foundat,ion---I"Q------- .� Septic Tank: Distance from nearest well- lbs[v - q p No. of compartments-1 ---- - --------- Dist' xs5 _ _" Liquid de0h --- Capacity ------ Disposal Field: Distance from nearest well_ �I +G Distance from found'ation__��__----------Distance:fio nearest lot line_-'_--""--"-- - Length of each line": - - - .d- Width of trench-_" "x- --- ` Number of lines------- :�-------- ------- • "-_"-- of filter material_")-9--- -Tota length---_J-------"�------------- Type of filter material - ' i Seepage Pit: D�stance to nearest we!!_-_"-____-_."_______Distance from foundation_._"_ "________.__.Distance to nearest o me__"__.--_".___-__ umber of pits Lining material. - Size: Diameter-'- Depth ; I ,Distance from nearest well-----------------Distance from foundation_""__"- -LLiEnu�d Ca eacil f--------------------gals. Cesspool: '❑ Size: Diameter---------3- f-------------- P Distance from nearest bui4ding.___..-____-'-------- Priv Distance from nearest well---------------------------------------------- :-------------- n ❑ _...!Distance to nearest lot line---------------------- • �------ modeling n or re irmg e ribe�: ------------- ' I�.. :::_:::::::::::::::::_: --- I hereby certify that I have prepared dulais application the aandn Joaquinhlocal Health e work will eDi District. ordinances.' accordance with San,'Joaquin County ordinances; State laws, and rules a 'regulations - wner an r Contract (O deo .1 . (signed) Ir -- (Title)------ ` (Plot plan, showing sixes of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE ----------------------------- -------------------- APPLICATION ACCEPTED BY- _ _. . �. .DATE ------------------------------- ------------------------ REVIEWED 13Y: '= --------- -- DATE----------------- -------------------- -- BUILDING`PERMIT ISSUED-------------------=------•--- - -------------------- i" .�?� datio s: --- ` Aite�rations and]or peg _ -- �-- ' -Q- - ' -- 11134A..-A-91- " -------- - --- - -------------------------- - - f �. Date----- © -- - --- CC -- 5�_ J--------=------------------ FINAL-INSPECTION-BY:.--.__'_ ,, - SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "c" Street Wes+ Oak $tree+ 132 Sycamore Street 130 South American Street 300 Manteca, California Tracy, California lF Stockton, California Lodi, California le 0 .OAA - Revised W-2100