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MIT Permit No. 3&_I-�---- APPLICATION FOR .SANITATION PER (Complete in Duplicate) Date Issued for a permit to construct and install the work herein described. �pji on is hereby made to the San Joaquin.Local Health Dist ric a an o. 549. cp p -- This application is made in compliance with County 0,rdin ce N JOB ADDRESS AND LOCATION------------ -------s, ---------- ---------------- ------------- Phone------------------------------------- Owner's Name---------------------------1____ Ii�------ -------- --------------------------------------------*------------------------------ Address-------------------------------------------------- -------------I------------------------ Phone----------------------------------- Contractor's Name------------------------------------------------------------------------------------------------------- I Motel 0 Other 0 Apartment House 0 Commerciait[] Trailer Court D ? e ...... Installation will serve: Residence T rooms . A_ Number of baths -------I Lot size ---------1SV-------- Number of living units- Number of bed -A Water Table -------- ft. Community system 11 Private 0 Depth to Hardpan [I Public system Ix am'E] ❑Clay Loam El Clay [] Adobe Water Supply: t: Sand [] Gravel [] Sandy Lo Character of soil to a depth of 3 fee Noo New Construction: Yes No [I Previous Applicaf ion.Made: Yes 171 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -------- ----------------- earest well____ --Distance from foundation-----N----------Materia.'I' r ------ Septic Tank: Distance from n P�h lt�k ---- ----------- No.1of compartments-----------:?L�:---- ----- -----Liquid de/ __...... . -----------Capacity x 11 k---------Distance to nearest lot line___�--------- iearest w31_.-----AM. ---Distance from foundation I Field: Distance from flh jjh,__40_X h-------- ---------------- OWidfb of fren Disposa Number of lines______________ ---Length of re --------- ----------------- jy' -_ ---------Total length---- .j ---Depth of filter rn�ater'a� Type of filter rr .�__idf I -------------- t nearest well- ----------- e from foundation--------------------Distance to nearest lot line__.__-_______._.. Pit: Distance to ---------Disfanc --------------Depth--------------------------------- ❑ Number of pits------------- Lining material_-------------- ----Size: Diameter------- ------------------ Lining material----------------------------- Distance from nearest well-----------------Distance from foundation ---------gals. Cesspool: T—A -----------------------Liquid Capacity- ----------------- Size; Diameter----------------------------------- Depth------------- --------i----- El ------------------------------------------ Distance from nearest building Privy- Distance from nearest well------------------- -------------- ---------------------------------------------------------------------- Distance to nearest lot ----------------------------l-i-n--e---I---------- ----------------- -------- ----- ------- Remodeling and/or repairing (describe):---------------------------- -- - ------------------------------------------------------ ---- ---------------- -----------------------I---- -•--•-------][+ wtj--------- -------------------- ----------------- ----------------------- -------------------------- ------------------------------------------------- --------------------------------------- ------- --------------------- -------- ------ ------------------------ -------------------------------------------------------------I----- --------------------------------------------------with San Joaquin County --------I hereby certify that I have prepared this application-and that the w�ork will be done in accordance w I t,o%s of the San Joaquin Local Health Disfrict� dd�' ordinances, State laws, and rules an regulat.�ns Contractor) J wrier and/or- ............... (Signed)..------• z4 1JXI-------- --- ---I------- I -----------------------------------[Title)_ I----------------------------------- ------------ By:_ ----------------------------------------- wells, buildings, etc.. can be placed on reverse side). (Plot plan, 5 owing size of lot, location of I system in relation to FOR DEPARTMENT USE ONLY DATE--------------�__ --- -------------------- - APPLICATION ACCEPTED B ----------------- DATE---------- ------- NO- ----------------------------- REVIEWEDBY-------------------------------- -------------- --------------------- ---------I--------- DATE------------------------------------------------------------ -------------------------------------------------------------- ---------------- BUILDING PERMIT ISSUED------------------------- ------------------------- ---------- --------- - -------------------------------------- ----------- i Altgrafions and/or recommend at'i ons: - ------ ------------- - --------- ----------------S_ -------------------------4 -- i 2 - -------I------------------ --------------- ----------------------------------------- r4—- ----------- V W- ------ ------------- -C, _4 -------------------------- --------- --------------------------- ---------------------------------- L-C - ------------ ---------—-------------------- A----- ----------------------------------------------------------- Date--- --------------- ----------------------- -------- -------------- PINAL INSPECTION BY:---------------------------------- -------- ------------------ SAN JOAQYIN,LOCAL HEALTH DISTRICT West Oak Street 132 SyCeMOTO Street 30O 814 North "C" Street 130 South American Street Lodi, California Manteca, California Tracy, California Stockton, California cc )KA io-59 Revised W-2100