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APPLICATION FOR SANITATION PERMIT Permit No. --- `/ ------ i (Complete in Duplicate) Date issued n I Joaquin Local Health District for a permit to construct and 'install the work herein described. Applica4ion is hereby made to the Sa Ordinance No. 549. his application is made in compliance with County Ord41 -7vw- ------------- --- -------- q� �k----------------------- .......... JOB ADDRESS Atil) LOC -- ------ Phone---Pl�^----- AT Nti -- ---------------------- ------- -------------------- ----------- -1114 ---- -------- -------------- -------- Owner*lqa!� --- --------, .. - ,e ----------------------- ------------------------------------------- ------ ------------------------------------------------ ............. ---------------------- 61__ Address.___.. --- ------------------ 4 t? Phone.06-----i--- -------- Contractor s Name_ ------- -------------------------------------- -j _, Installation will serve: Residence [g j Apartment House 0 Commercial E] Trailer Court [j Mo elOther [3 -- ' --- -------_--------------- ------- Number of living units' A----- Number of bedrooms '.- Number of baths j.... Lot size — I S -to Water TableA. 0__j.t' Wafer Supply: Public system El Community system 0 Private &J"'Depth to/Hardpan ❑ Character of soil to a depth of 3 feet:: Sand Gravel El Sandy Loam Q Clay Loam Ej Clay ❑ Adobe Previous Application Made: Yes Fj No a�pNew. Construction: Yes &3"'No El TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) p within-200 on---- _377. ------ �No septic tank or cesspool permitted.if public-sewer is ava . ,. --7— i I() Mai rial--- arest well__n�0 Distaric from found'a ---------------- a7 M I i4" apacity---- Septic Liquid depth Distance from nearest S V;Zn k No. of--cornpartmen 7, . . 44kjq-' � nearest wO---��'O_��Di,tance rom o6ndafi-on 40 .--_---.__.Distance to nearest lot line---------------- Dispos Id: trench__________ ------ ----- Distance from ne _./4__ ._.Width of --------- - Number ol lines----------------•----- -----------Length of each line---- Total length-----1775:4--J�---------- 'Type of filter-m6ferial--- ---------Depth of filter material--- -- ------- -Y—_Distance to nearest lot line__`_________._ from foundation____.___'__Distance to nearest well__t--F9_'7 -Distanceion -------3P-------------- Seepac.v_/Pit umber of pits----- ------.Size: Diameter---- N ---Lining mafefial.A from fou I ndafion------------------Lining material-------------------------------------- Cesspool Distance from nearest well-----------------Distance ... -----------------_Li quid Capacity—----------------------_-__gals. ❑40_� Size: Diameter--------------------- ------- -------Depth----- ----------------------- ance from nearest building_----:-----;------------- ------_, ----Dist Distance-from nearest well---------- ----------------------------------- rivy: ------------------------- -- ---- f`'„'`-``to nearest lot line. ------------------------- -------------------------------------------------------------- Refnocleling and/or repairing (clescribe):__450!n�_.- ------------------------ --------------------------------------------------------------------4---------------------------------- -------------------- -------------------_---------- -------------------------------- --------------------------------- ----------------------------------------------------------------------------------- ------------------- J---------------------------------------------------------- --------------------- ------------------------------------------------- --------- ------------------ ------------------------------ ---------------------- 1)-------------------- ---------------- --------------------- ------------------------ -- . and that the work will be done in accordance with San.Joaquin County I hereby certify that I have prepared this applicationf the San Joaquin Local Health District. '`ordinances, State laws, and rules and regulations o . - I /or Contractor) --------------------------------------- ----------(Owner and (Signe ---- --------- ----------------------------------B ------- ------- ---------- ------------------- ---------- ----------------- ------- -------------------(Title)---- -sysf em in-—re%fi�on+o--w`ells:66ild iri�, etc., can e p 6 de on revers g size�o -lot.-1o�ion of FOR DEPARTMENT-USE ONLY -------------�: _ ----- DAT E_ - -------- ------ ------------------------------ ------------------------------- APPLICATION ACCEPTED BY----- ,; -- DATE- - REVIEWEDBY------------------------------------------------ ------------------------------ -------------------- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------ ------------ � I ---------------- ---- ------------- -------------- ------- - ----------I-------- Alterations and/or recommendations:----------------------- ------------- ---- /U'r ----a*?_ --"- -',- -------------- .4 &Y�?71/1't.....a.,- -- -�__.�-�....... -__.. ----- --------- ��124;� 1�r ............... -------------------------- ----------------------- ---------------------------- ------ - -------- -------------------- aL -- ---------- --------------- --------------- ------------- -------------------------------------------- -------------------------------- --- -------------------- -----------------I------------------------------------------------- --- ----- ---------------------------------------------------I ----------- ... ... ------------- ----------------------------------------- ------- ------- ......-7----------------------------------------- FINAL INSPECTION ------ ---------- Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 13o South Arneric�an S+rse 300 West Oak Street Manteca, California Tracy, California Stockton, California Lodi, California E S-9 145446 ATWDOD