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f� Permit No.,�!'`�_7. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for ibed. a permit to construct and install the work herein descr This application is made in compliance with County Ordinance No. 549. .. _ ----- -- _ ----------•------- JOB ADDRESS AND LOCATION__.. -- - --------- ; �1-------<---- .. - -------- one------------------------------------ ---------- -- -------- --------------------- Owners Name = . .. -------------- Address ' - --- -- - ------ Phone--- ---� --�- ---- --dr. --- --- 4 Contractor's Name_________ _ __Q ommercial F] Trailer Court ❑ Motel ❑ Other E]Installation will serve: Residence ApartmentF-1 House C 7_�:•�---�. --- }. Number of living units: __/--- Number of bedrooms _'Number of baths`"__r_.__ Lot' size --------- -z o------------- : Water Supply: Public`"system ommPrivate ❑ Depth unity system ❑ +to Water TablAXV ft_❑ Y Adobe ardpan El Character of soil to a depth of 3 feet:i Sand El ravel El Sandy Loam ❑ lay Loam Cla ❑ ; Previous Application Made: Yes ❑ No New Cons+ruction: .Yes No El 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Tank: Distance from nearest well_________________Qistance from foundatiLn Liquid de th__Material---------------Capacity___ F ). ❑ /moi/ ' No. of.compartments - Sze .:. 3 q � � ' �, -_---_.Distance to nearest lot line__/6)----•.- Disposal Fie Distance from nearest well��W- ----Distance from foundat'son___ _ _P 1Len tb cf each line_ _sr'�-GQ-- ----- Width of trench_. -- -------- or Number lines:__._ - g' j/ Barest lot line_________________ De th'of filter material_-----/ �-------Distance o n Tota! length-_____ ____ Q- Type of filter material�,�„_ - '-- p Seepage Pit: Distance to nearest well----------------------D'sstance from foundationDepth--------------------------------- ❑ Number of pits----------------------Lining material-----------------------=Size: Diameter____'____------- I. Cesspool: Distance from nearest well_____________ _Distance from foundation--_._.___-..___,___ Lining material________________------ gals. l Size: Diameter----- ---------------�-------------Depths--------------=-- ----------------- ----Liquid Capa_citY _ .� _ { • ._..,� _ ❑ --^�- � '�,"" � �� '� � � -_Distance fromnearest building-__._---�--------------��---� , Privy: Distance from nearest well _ _-____ __-----__ -•-- --- ❑ • Distance to nearest lot line--------------------------------------------------------------------- 00 l (describe): --Remodeling and/or repairing [describe :____---- '- ------- -----------• - - ----- - - ---------�-------- ------------ ---------- ----------------------------- -------- -.. .. I hereby certify that l have prepared his application and that th work will be done in accordance with San Joaquin oun y ordinances, State laws, and rules and regulations of the Sa Joaquin Local He Ith District. , s �. ______[Ow and/or ntractor) ------- (Signed) Ar-Tr �- -- ll� ( --- By: F.. ------ -------------------- (Title- (Plot plan, showing,si, of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. r FOR DEPARTMENT USE ONLY ; t ' LDATE — --------------------------------------------------- APPL1CATlON ACCEPTED BY_ --------�------------•--------------------------------------------------------------------- DATE REVIEWED BY ---- \---------------- - --- - - - DATE-- �- -`�-,---------------------------------------------------------- I ----- ----- ------------- - -- Alteration ons PERMIT ISSUED--------- ---------- - - - q and/o recommendations:________-y —_- - { -- ----------------- --- ------- hh ------------- .---- E -- --------------------------------- f LtJ�'at dam.- �. Date- --------- -- - 3 1 i � ----•------- ------- --- ----- - - FINAL INSPECTION ----- -- -- - CTION BY:______ k 8�A IN OC ALTH 4 N "C" Street 132 S ea re Street 81 134 South American Street 30D West Oak Street y Tracy, California o.. Stockton, California Lodi, California Manteca, California 4 r ES-9--2M 10-52 Revised W-2100 __