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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued pli Ap .I� T� cal-i on is hereby 'mad. !,a the San Joaquin Local Health District for a permit to construct and install the work herein described. 's application is made in 40' mp iance with County Ordinance No. 549. JOB ADDRESS AND LOC 0 TION. 04A�__ ---/Ot� Owner's Name------W U 00, A60- ------- ------------- ------------------- PJ --------- Address-.--------- hone- -------------------------- ------------------------------------------------------------------------------------------I---------------------------- � Contractor's Name--__-_Aoal ------- ---- -- -------------------- .......... Phone---... ---------------------- Installation will serve: ResidEvnce9LLAparfmenf House Commercial Lj Trailer Court El "�Aof el E] Other ❑ Number of living unitt f----- Number of bedrooms Water Supply: Public systei ;"umber of-baths Lot size --- --- m C] Community system Private OLDepth to Water Table _-�'_—ff. Character of soil to a depth iN f 3 feet: Sand X Gravel [] Sandy Loam 0 Clay Loam E] Clay El Adobe E Hardpan E] Previous Application Made- !Y El NoK— New Construction: Yes No ❑' TYPE OF INSTALLATION )Nle)s SPECIFICATIONS: I) (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: DistanceA from nearest we 0A I f, IL-Jip--_.._-Distance from foundation----Atop-, Material_4,C!-!--e- No. of compartments--- — ----------Size---- Liquid depth------- --------------------*-- - --------- III --------Capacity--l---- -------- Disposal Field: Distance .from nearest weil- Distance from foundation---;7d__t----Disfance'fo nearest lot line-,/40-1 Number 011f lines---------/------- - -- -Length of each line----_--AP-_'r------EF Width of french-,,;2 - --------------------- Type of lfer mate-rial---- - .40 Depth of filter material... ... --------Total length----- -------- Seepage Pit: Distance Ia nearest well----------------------Distance from foundation... Distance to nearest lot line El Number of p;fs ----------------- ---- ---------------------Liing material---------- ---------- Diameter-----------------------Dept h------- 0 --Size: Cesspool: Distance lrom nearest well- --------------Distance from foundation...-- 1------ Lining material--------- , ---------------------------- El Size: Dial eter--------------------------------------Depth---------------------------------------------------Liquid Capacity---------• -----------------gals. Privy: Distance fr m,nearesf well------_----_--- ---------------------Distance from nearest building---------------------------------------- k F1 Distance to nearest lot line------------------------- ---- - Remodeling ine-- -------------------------------Remodeling and/or repairing escribe);------------------------------------- ---------------------------------I --- .- --------------------------------------------------------------------------------I---------------------------------------------I-----------------------•------------ - ----------------------------------------------- ------------------------------- --- •0----------------------------------- ---------------------------------------*----------------------- --------------------------------------------- that --------- • ----------------------------------------------------------------- -------------------------••------------------------- --- -- --------------- I hereby certify haf I haIpe prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S!tf�aaw and rules and regulations of the San Joaquin Local Health Distr icf. (Signed)---- • IIS: ------------ 8) ------------------------------------------------------------------------(Owner and/or Contractor) ------ ------ ------_--------(Title)......g5,449, ----------------- ------------------ (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 81 ------------------------------------------------ - I DATE-------- _.1 -- ----------------------------.--.--.--.t--------7REVIEWED BY ?--------- - - ---------� -- BUILDING' PERMIT ISSUED -Q ----------------------------------------------------- DATE--------- - -------------------------------- DATE_ - ---------------Alterations and/or recommendafions:----------- ------------ ------------ - ............ =--- -- --- I---------------------- ------------------------------------- ------------------I--------------------------------------------------------- ---------------------------------------------Q-------------•--------- -------------- ----------- •------•----•------------------- ------------------------------------------------- ----------------------*-------- -------------------------------------------------I--- ------------------- ------------------------------------ ---------------------------------------- ------------------------------------------------------- ---------------------------- I --------- ---------------- -----I------------------ ------------------------------------------------------ --------------------------------------------------------------- ----------I--------------- ------------------------- ------------ --------------1 11------------- --------------------------------------------------------------------------------------------------------------*-------------------- FINAL INSPECTION BY-------I--------- -------- _1 wz _� ---- Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California Manteca, California . .814 North "C" Street Tracy, California 145446 ATWC30D 12-54 1 41: