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FOR OFFICE USE: - ----------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . �1_ 4,1� -------------------- ------------------------------- (Complete in Duplicate) ----- I This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a `f ffo pemit to construct2and installs�i the—f work her described. This application is made in complianc with County Ordinance No. 549, fCgi JOB ADDRESS AN OCATIO ��_N. -.-i _C Owner's Name---------- �_A L-V -. - --------- --- r Addressr ----`- x _.... I' _ � Contractor's NanI..._ W— �� F..- -•• ..-.:. a ---------- Phone—�-J.!r--.4_ + _1,t Installation will serve: Residence parfr;r- ousel Commerciot Trailer Court � Motel❑ ❑ j, ❑Q o el ❑ Other ❑ Number of living units: --I---- Nu'nber of bedrooms . Number baths :F�-. o+ size . --____-. .._ Water Supply; Public system ❑ II munity syst ❑ Private }Depth rAla Water Table 7— ft. i . Charac# r ofloil"to a- epth�fa3�,'�eet: 5ancl Cravel4� Sandy.{Loam ❑ yrLoam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application M. (if yes,date--------------------) No New Construction: -Yes o ❑ FHA/VA: Yes ❑ No ' YTYPE (No septic tan or cesspool permitted if public sewer is available within 200 feet)104 t F-INSTAL-LAT�p- ANDNrANDFSPEC-iF[CATIONS: Septic Tank: Distance from near w � P est well _____--Distance from foundation.'- ,-.Material.Y_.Material---------------------------••-�----- Disposal � No. of compartments = Size '-----------------Laiquid dtpth._', - Capacity ----------------------- Number of lines---------- -------- -------------Length of each line_-_tion_-_ � - p.istance to nearest lot line____ � ' ,meR Id: Distance from nearest well-5-0...Distance from foundation j` u L� ---- th - c 9 N dth of trench...----2 4--- -__ Type of filter material._M-C�_ p � C De th.of filter material} / __-----To d1 length----------------•- .� . --------------- Seepage P t: Distance to nearest well_ Distanc from foun a .-i i M ce to nearest to lin — Number of pits----__� g ------ -------- I� Linin material- L 1 Size: Dlemeter---- _ Depth ❑Cesspool: Distance from neerest well--------------a-Distance-frbmwfo ndation...... _.------.Lining „aterial------------ ---------- Size: Diameter/' ....... Depth--------j- -------------- ---Liquid Capacity---------------------------gals. Privy: Distance fr1nearest ell-------------------------1 7► _Disf'ance fromNnearetst building _ ❑ � Distance to Barest to• line---____--_-.__ - I Remodeling and/or repairing ( 'escnbe]-----------------------------•----------- -"---._..----------- - ------- -----•------ --------------'-----•----------------•--•------------ -----•-----••-•- ------ •---- 7--••-------------------•------------------------------ --------------••----------------• ------------------------------- ----••-----•---I-------•---- ---------------- -------------- --------------------------------- • ---•--------s-------- ------ I hereby certify that I have prepared his application and that the work will be done in accordance with'zS in xloaquin County ordinances, State laws, and rules and regiations of the San Joaquin Local Health District. } cA {Signed}_- -.1---------------- Q -.. �.� I"" _ ..._,� - --- -------------- --:--- ---- - --------------------- -x--------------- (Owner and/or Contractor) - { }. —. B' • t --- -- ---- --------------------- -- - --- ----- - - r - rile (Plot plan, showing size of lot, I1cation of system in relation to wells, buildings, etc., can be pieced o re a se'sidQ.7 ""`- 1 FOR DEPARTMENT USE ONLY r ---------- ----------------------------- ------- DA�E l�� APPLICATION ACCEPTED BY �_ � ___ __________ �---_c-��------------ REVIEWED BY --- I--- ---- -- ---- } ---_ DANE.. BUILDlN6 PERMIT 15S.UEd.. - �• - xDfAT.E. ---•--- :...-,... i =- - ----------- Altera+ions and/or recommendations---------- ---- - ------- -- -------------------------I-------------- --------------•---------...------------- ------------------------------------- -- .- . II_ J � ------------------ - , --------:!I .� ---- , . ----------------- ...............---- ---------- -. ---------------------------.-...------•--............ L4L -- -------- -- --------------- ---------- L--- .--.-_-••_--•------. 5-__• ----------------------------------------- -----------I----------- ---------- ----------------- ---`- ------------ -- ---.-.-----•.-------_-----•-..-------- •--••----------.--..__..ry t-..-.-.--.-..-----------.-.------------ FINAL INSPEGDate - - - --- --- -•--- ----- ---- ---- -- Date--------�%!T� SAN JOAQUIN LOCAL HEALTH DISTRICT 130�!South American Street 300 Wert Oak Street 124 Sycamore Street ZOS Wast 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8.59 2M 5-62 ATLAS