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i APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued --...--- ------- - ion is hereby made to the San Joaquin Local Health District for a permit to construcn� installthe herein �s�bed. Applicat Y `�� `� This application is made in 'compince with County Ordinance No. 54 JOB ADDRESS AND LO-AVON... `2i�k-------- ---- Phone-------------------- Owner's Name------------------=- -r r-- : -------- ----------- 76 ev Address r �' -----"------ Pone----------------•------------ Contractor's Name--------------------------------------------------------" Trailer Court ❑ Motel ❑ ter installation will serve: .Residence )Apartment House ❑ Commercial ❑ / I E Number of living units: ,_1____ Number of bedrooms- -_ Number of baths /__ Lot size s- . Communit stem ❑" Private ®/(7epth to Water Table/4_ a ft. Water'Supply: Public system ❑ Y s y a Clay ❑ Adobe Hardpan'❑ Character of soil to a depth of 3 feet:: Sand E] Gravel [I Sandy Loam ��Y Loam ❑ No [ New Construction: Yes � ❑ FHA`/VA: Yes E] No Previous Application Made: Yes ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if puic sewer is available within 200 feet) 0 C -- { well-10_f__-_----Distancet fro faunion �-_,-----------Material-44— Septic Tank: Distance from nearest -- - ,/ F No.'of compartments------ Size_-It--�- ---Liquid depth----�--------------- -Capauty_._ ® / -0-- "-__.__- Distance to nearest lot life.g------- ---• } Disposal Field: Distance from nearest well_--.------Distance from foundation_ Len th of each line------_349::-. - ----- ----Width of french �Z - � Number of lines____-_ g ..........Total length- Type of of filter material__ 1__1� � --Depth of filter material__��._-- .� - ` Seepage Pit: Distance to nearest well____---�__________--Distance from founds Zia nDiameter"-.Distance toDnepst lot line p Number of pits---------------------Lining material----------------------- ❑ s,. Cesspool: Distance from";nearest well____________--__Distance from foundation._--_____-___---.Lining material-- --- gals. P Depth--------------------- ----- Liquid Capacity 9 ❑ Size: Diameter-------------------------- Distance from lnearest well =---- Distance from nearest building------------------------- --------------- Privy: --=--- -------------- ❑ - - Distance to nearest lot Ione-h__-:=----_�--- - _• -- =' µ q = ---------------=-------- Remodeling and/or repairing•(describe)----------------"------- - ------------------- ----------•---------------------------------------------------- ----j, ------•-------------------•----- - -------------•------------------•--------------- ! hereby certify that I have-- '-------------------- `----------- ---- ------------------------ County _ ------- ------------- ---------- --------•-------- e prepared this application and that the work wi11'6e done in accordance with San Joaquin oun y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. e - � t "--- "-_-____(Owner and/or Contractor) (Signed)- _ ---------- ------- ---------. . ----- - ------------ 4 - --------- - _ (Title) :. ---- ----- -------------- -----------------------------=---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). FpI EP, RTNi 7 U51` %NLY ° -� -------- . ��r`"" ."DATE_/ --- APPLICATION ACCEPTED BY_-' DATE"----- --•---- - --- REVIEWED 8Y_- = - ----- ---------------------- DATE --------------------------------- BUILDING PERMIT ISSUED ------------------------- --------•-------- -------=---------- Alterations and/or recommendations:_______.___--____-- _-___-_-- _ ------------------------------------------ ------------------------------- ---------------- -------------- Date -- _.. = „ w - 4-- ----------------------------------•------- FINAL INSPECTION BY:.:.__"-----` - - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 300 West Oak Street 130 South American Street Manteca, California, Tracy, California Stockton, California Lodi, California E5-4-2M , Revisea 1.57 r.P.CO-