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--------------------------- -------------------------------A-------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ../3__....... --------------------------------------------------------- (Complete in Duplicate) - ------------------------------------------------------ This Permit E*pires 1 :Year From .Date Issued Date issued .1 — ; Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desC This-applLcabon,is-made.jn co liance with County Ordinance No. 549. JOB ADDRESS AND ON-AW 417 71( - 15ev C) Owner's Name 1�-------// ----------------------------------------------------------- ---------------------------- Phon - --------------- aO ,4,V_Ayl Address""--------==------- Contractor's Name-------....... -------- .... Phone.._"........." --=------- Installation will.serve: Residence JRApartment House E) Commercial ] Trailer Court E]. Motel ❑ Of her E] Number�of living units: ---/___ Number of bedroom's N6mber of baths Lot r size ----I __1�_x S-0 ( I -- ------------------------------------- Wafer Supply:"' Public system 0 Community system gelPrivafe'El �'Depth'to Water T'alale 4- K ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Vr_-Clay Loam 1 13 Clay El Adobe❑ Hardpan, Previous Application Made: (If yes,date--._---------------) No P`_-New Construction: Yes P-Io Ej PHA/VA: Yes El No: --'w-TYPE'OF;INSTALLATIC)N--ANW5PECIFitAfiO—f4g.- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 41, _ T. Septic Tank: Distance from nearest W f J ew,,,,,ee& Distanc�)from oun afio ----------Matefv,al.,-. _------------------ No. of compartments:--------------;( ...... Si,e_5�.x-1`-rpg:-------Liquid depth_t•---lk t e.4----Capacity_.___1T0_0,_9,4A Disposal Field: Distance from nearest well..7,6-49-----Distance from foundation _00r---�Isfance:to nearest lot line---- -- ----- Number of lines----___;_Z_ Length of eachlne-------- Type of filter ma LOpt FF t ------------------ ------Width of trench-------i;;9' material----Y!A� " Depth of filter material------/ ------------Total length----------/ ..."____ "-_ Pit: Distance to nearest well---- ----------------Disfanc"efrom foundation---------------------Distanc;'to nearest lot line---._"__.___;"... 0 Nuiber of,pits--------I--------------Lining material-----------1_---•-.-------Size: Diameter--------------- ---------Depf h ----------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_------------------- ETSize. Diameter------- ------------------------------Depth!-------------------------------------------------Liquid 11 Capacity----------I-----------------gals. Privy: A Distance from nearest well------_---_"--------- ---- --I---------- _-Distance from nearest building_"-_"."""."_--_-------._____-------- ❑ '11 Distancelo nearest ]of line-- ---------------------- %I------------------- . mss- �---------------------------- ---------------------------------------------------------------------- --------Vlj_tjo:� -A'4, -------- ----------car_L-4-�----------I------------------------------------------------------ --------------------------------------------------------------------................... -- ------- ------------------------------------------ ----------------------------------------------- -------------------------- ---------- ----------------------------------------------- ---------------------------I ---------- --------------------------------------------------------------------------------- 11 --------------- r 0 --------------------------------------------------------------------------------------------------------------------::-------r-,----------------------•-----------_---•-- I hereby certify that I have prepared this application and-that the work will be done in accordance with San Joaquin Courify ordinances, State laws, and 'rules and regulations of the San Joaquin Local Health District. (Signed)-- -- -- --------------- --------------- ri -----------------�.L------------------ .wne_nand/or S., le)-------------- --------------------------------------------------------------------------- -------(Tit -------------------------------------------------- (Plot pl. wing size of lot, location of system in 1;relation to wells,, buildings, efc.,, can be placed on reverse side). R DPARTMENT USE ONLY APPLICATION ACCEPTED'BY' DATE------- --- REVIEWED BY ------ ------------------------------------ -------- -------------------------------- ----------------------------------- F---------- DATE------------------- BUILDING PERMIT ISSUED-----------------------= -------------------------------------------- DATE-------------------- Alterations and/or-recommendations:-_---------------- # ------------------------- -----------------__-----------------------------------------------------------------------I-------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------- ---If------------------------------------- ---------------------------------- op ------ ----------- ---------------------------------- - ----------------------------- ------------------------------------------------ - --- ----- ----------- ----- --------------- ----------------- -- ----------- --- ----- -- ---------- - ----------- - -------------------------------------------------------------------------------- ------------------ ------- ---------------------------------------- -------- FINAL INSP rIO Da-----------17:n--a ECT SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED B-60 F'.F,CO3 Sr.6.60