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Permit:No. _-/�-c�--••�Y APPLICATIO14 FOR SANITATION PERMIT `T (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �, - ----- - - JOB ADDRESS ANDLOCATION------ -- .1�s�7�7 Owner's Name -------- ----- 7� �- = --�2�7 -:;�----------------- Address on ---- --------- t "�' C--------------------- - Ph Contractor`s Name---- 1 ------ ------. , # f Motel ❑ Other ❑ Installation will serve: Residence ❑ !Apartment House ❑ Commercial ❑ Trailer Court ❑ J Number of living units: --- Nu ber.of bedrooms �`_ Number of baths__----- Lot sae - - 7�• " Water Supply: Public system Community system [IPrivate E] Depth to Water Table -_ ft. Character of soil to a depth of 3 fee I Sand ❑ Gravel El Sandy Loam ❑- Clay Loam ❑ Clay E] Adobe RI Hardpan ❑ Previous Application Made: Yes El "No 0 New Construction: Yes K No ED TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer.is'availabke within 200 feet.) I A' Tank: Distance from nearest weIIA J,� l Distance from foundation--.-�d__-.------.Mai real-------- Septic Tan n Dd No. of compartments------ ---------- -SizeS6.._}<</6S-•--;L�gwd depth-- � -- Capacity- -- -- -------- Disposal Field: Distance from nearest well/Y.O&'-Distance from foundation---7--------:Distance to nearest lot line------�i--- 1 -----------Length of each line------r,--- s------------------Width of trench ��•• NumbeNumber of lines___r___-- _.-- -- •� � Type r filter material sc I o. --_----Depth of filter material---I-e--..------..Total length-----.?��T----------------- �--V oT' /D„ I �.--._.Distance to nearest lot line----------------- Seepage .------__-----_ See a e Pit: Distance to nearest well� .-0�//--Distance from foundation____ -_-- p 9 C ize: ` Depth----- Number of pits_--I-L-____--- --Lining material- -�Zz�� --- Diameter--..._�_--_-------- .r Cesspool: Distance from nearest well----------------- from foundation--...__.--.---_ Lining material------------------------------------- Cesspool: ----_.-_--- ..--_-.- _--- Li uid Ca -cit gals. ❑ Size: Diameter--------------------------------------De th----------------------- --- -----------; q p Y (��. ` from nearest buiiding----------------------------------------- �1 ` Privy- Distance from nearest well-------------- ------ - - Distance k, Distance to nearest lot line-----------------------_ ------------------------------------------ ----------- ---•---------------------------•------------------------ Remodeling and/or repairing (descr'ssbe)-------- -- ------ ------------------ -------------------------- ---------------------------------------- ----------------------- ---------------------- ------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin.Local Health District. t (Owner and/or Contras+or) Signed ----- - ( 9 J I {Title)- ----------------- -------------- ` By:-----�'�___ --' "= ------------------= (Plot plan, showing size of lot, to v tion of system in relation to wells, buildings, ate., can be placed on reverse side}. - FOR DEPARTMENT USE ONLY _�� --� j DATE �/ ------------------- VA-5- --- ---- APPLICATION ACCEPTED BY--`--=-=----------- REVI ---- REVIEWED BY -f --- ------ DATE---- --------- ----- -- - - i BUILDING PERMIT ISSUED-------------- ------ Alterations and/or recommen -tions:.---__-------------------------- - --------------------------------------- ----------------------- ------------•--_ ------------ -------------------------------------------------------------- ------------------------------------------------- ----------------------------------1--------------------------------------------------- -------------- ------------------------ ----------------------------------------- E / ----- ----- ----- -------------- -------- ,FINAL INSPECTION BY:---------- -- /-- ------ --------- - Date 1/ --, I SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 30D West Oak Street y Manteca, California Tracy, California Stockton, California Loeli, California r ES-9-7M 10-52 Revised W-2100