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1-UR QFFICE U E: � � APPLICATION FOR SANITATION PERMIT Permit No. .�_Z`i � --- ` ---=---- �, (Complete in Duplicate) ., w --- ---------- This Permit Ex ires 1 Year From Date Issued Date Issued 3'-.tel__ILI Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described, This application is made in compliance with County Ordina ce No. 49. ,• ti s � JOB ADDRESS AND LOC Tl17-1 C -------------------------------------------------------------------------••-------------------------- x Owner's Name-____-- �--------------- ------- .-.--- aR - --------- Phone 1+. Re-----_------------- Address -•- - - . ------- -------------------=-------- -•--------------- --•--------------- -- Contractor's Name. - - ---•----- =----------------------•------- - — ' '----- Phone__--•-------------------••-•--- .. Installation will serve: =Residence ["Apartment House ❑ Commercial ❑ Trail` Court E] Motel [] Other ❑ Number of living units: _-/__ Number of bedrooms .&- Number of baths h - Lot size. - � ---------------------- Water Supply: Public system [+Community system ❑ Private ❑ 'Depth to Water Table.; 197 ft- Character of soil to a depth of 3 feet: 'Sand Gravel Sand Loam P ❑ I]' y� ❑ - Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--- ------) No P New Construction: Yes Ilio ❑ FHA/VA: Yes 9''140 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) —�- Septic TAO: 4 Distance from nearest well_,_�O_ --1-Dista ce from foundation--- _ A No. of compartments_-_--- --------- ----Size - -------_-Liquid depth--- �------ ------Capacity-. _ Q.._.. ; fo - 9 ! Disposal Id: Distance from nearest well -_-.-_,Distance from,foundation-__.-..Q----._ Distance to nearest lot line---_---- Nuinber.of-lines---._-'-e2- --- ----- --------- Length of each line--- ----_--____--.Width of trench-.-+� _ ------------ Type of filter material s?G Depth of filter material--� _- _- ' / - - ------Total length---��rl��-------------•-•-----•---- �. Seepage : Distance to nearest well- _____ •_ Distance f n foundation- r Distance to nearest lot line-��_______ Number of.pits----. .--________Lining material---_ it--- _Size: Diameter_90___-_-.----.pepth__-,e _- _------- Cesspool: Distance from nearest well----- Distance from foundation 'Lining material_- -_----_--_----------------------- O ❑ Size: Diameter------- i----------------T-- ------Depth - -Liquid Capacity -------gals. t ` . ------------------------ ------ q p Y=-----------•------- Privy: Distance from 'nearest well -----_._.._.?_______________________-_-----Distance from nearest building---------------------------------------- El Distance'to nearest lot line- ----- ----------------------------A ---------------------------------- Remodeling --------------------------------- Remodeling and lor repairing e ribe):-----/j/. -_ __ - �• •- - _ - , , -- ---------- ----------------------------------------------------------- 7 -- - _ --------------- _- ------- -- ------ - - ----- - - - -- ------- I hereby certify that I have prepared application and that will ine in accordance with San Joaquin---------------------- - ordinances, State laws, and rules,and regulations of the San Joaquin Local Health District. uin Con (Signed)--- ' By:-------------------- =-------= =- "-------------------- ----------.----- r Contrast orl ' i = = (Title) ,------- - ---- - --------- ---- (Plot plan. showing size of lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ s C3 -� -=� `-- ----------------------------------------------- DATE---- -- ------ ---------------------------=-- REVIEWED BY - -------------------------------•---------------------------•-----==------------------------- DATE ----------- BUILDING PERMIT-ISSUED-----------I------------------- --------•---------••------------ =-------------------------------- DATE Alteratio[is ani! or rec m endafions:.___%---------------- .. - = f /F� r- M1---------- ff......... -- - ----------- - - - -•-- - --- • ry ,.. e - -- ---- - --- ------ ------------------.-----------------'..--..----- ----------------- --- ----- - 3- - --- FINAL iNS EC ION t -- --=-=----- --- "Date-----`- ---- ---•-'- --- ---- ------------ ------ -- -•- - •--�------------ t 3 -1101 V w-2.. d_&z/ c.�aQ ',h r" ion► ,,,L9..11 wgZZR. -SAN JOAQUIN LOCAL HEALTH DISTRICT 1D-�ti111�4meri�. , ar ,gj West Oak Street ]24 Sycamore Street y: _. j t , 205 West 9th Street Stockton,California Lodi,California Manteca,California' Tracy,California Ee•9 FEVIBEO a•69 r.P.CO.2M 6.60 .�C�YLC'--f'+-!�l'�g�r��-Lt-�.� ��Y7i-� / .� �c_ -�.,rC7-cl.,t7•C"2�� `� �/