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APPLICATi0 SANITATION PERMIT Permit No. irOR �, .: (Complete in Duplicate) pate Issued � �---- :�3 Application is hereby made tfor a permit to construct and install the work herein described, o the San Joaquin Local Health District This application is made in compliance with County Ordinance No. 549. �! o" - �/ -�^'' -------- o- .----- JOB ADDRESS AND LOCATION------------------- +_- - - 1. ------------ __--- Phone---�=-��`� Owner's Name " �1--' _AL-Arn-6��-�� ------- - -------- •-- ------------- ••--------------------------------- Addressf Contractor's .Name---------------- � -�,Gr---- - ------- Phone-----.��--�-o�----- Installation will serve: Residence CK Apartment House ❑ Commercial ElTrailer Court ❑ Motel ❑ Other El �� ---------------------- Number of living units: ---I---- Number of bedrooms " _ Number of baths Lot size Water Supply: Public system �- Community system ❑ Prwate Depth to Water Table 4Q ft. Clay Loam Clay ❑ Adobe�. Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y ❑ Previous Application Made: :Yes E] No X New Construction: Yes 5Z No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publi newer is available within 200 feet.) L�- Tank: Distances from nearest well-- ----Distance from faun dation_--f" --.-=----Maul_""-------Ca, acit ,�o-c ----------- Septic No. of compartments..--;Z-.- - -----Size� _- _0, --Liquid depth-- ----------- p Y . ! Ors Distance trom fdundation___�-.C-------Distance to nearest lot line_/d._" Disposal Field: Distance from nearest weil,l. p -----------Width of trench_-�- ----------- --------- Number';of lines_-_"�-----------------------------Length of each line---_- -- ' Type of;filter material._-"t_y - - -_Depth of filter material----- r-----Total length---- rest to�• a1. .S-- ----.Distance to nearest lot "�---- Seepage Pit Distance to nearest well_�QO'_-" ""--Distance fr m founds#ion"- i� pe th__.1Cr-rte-------------------- Number" -�-- Numbe II of pits----_"J<-------------Lining material-V-10.- - Size: Diameter"-- ,5Z- ------ P I Cesspool: Ristance from nearest well-----------------Distance frm oundation--------------------Lining material .---".-- - als. ------------------ Liquid Capacity g ❑ Size: Diameter------------------------------ -- Depth- arest building----------------------------------------- � - - Privy: Distance from nearest well------------------------------------ ---__"_ _Distance from ne ' ❑ Distance to nearest lot lire.__"--__-.-_""-"__--__-._---_--"..""""_- - -------------------------- - --------------------- -------------- --------- Distance to and/or repairing (describe):--------- ----- -------- J ---•-------------•----------------------------- ----------------- ---------------------------- 11 ----•------------•-----------•-----------------------------------•---- = ------------------- ----------------- I hereb cerfify that 1'have prepared this application and that the world w�h be done in accordance with San Joaquin Count ordinances, to laws, and rules.�a d regulations of the San Joaquin Local Health District. Contractor) {Signed} ----------- ----------- t Plot plan, showing size of! ;- - - ------ By: ----- '�° - -- B :--------------------------------I F { p g lot, location of system in relat i to wells, buildinv , etc., can be pl ced on reverse side}: I� FOR DEPARTMENT USE ONLY DATE--------- '-- -b ----------- APPLICATION ACCEPTED BY---------------------moi - - DATE-------------------------------•-------------------------- REVIEWED BY------------------ "--------------------------•-------------------- - DATE-- - ---------------------- --------•--------------------- -------- ----- • - BUILDING PERMIT ISSUED--------------------------- - ----"----- ----------------------- Alterations and/or recommendations:---------------------------------------------- ---------------------------- ------- ------------------ ---------------------------- ------- ----=-------------------- --- --------------- ------------ -- Y1t Date - - ------- ------------------------------------------------ FINAL- INSPECTION BY-------- -------- --------------------------------------------- ii II SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Tracy, California Lodi, California Manteca, California Stockton, California;; E5-9-2M io-52 Revised W-2100