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Permil No. -c.�--- r APPLICATION FOR„SANITATION PERMIT (Camplefe}n Duplica } EXPIRES ONu XEAIi D e Issued .___�!.!__S(J. - F:ROM 73ATE /de work herein described. Application is hereby mfo then Joaquin La cal Health District for a This application is made in compli nce with County Ordinance No. 549. TION. -------� �..-._.. JOB ADDRESS A B LOCA Owner's Name-------- • ----------- F Phone-------------------------------- _ - Add ress---•--------- w_6�.~ :. , ��,. 1------=----------------- ----------------------------------------------------•-•-------------------- �,y�1,L.y;-s " hone-_-"----------- •--------"------- Contractor's Name-- ----- - ----�J?•------ -------- -- ----------- ---------------------------------------------------- P �.. ': Installation will erve: Ressdence. " partment House Commercial ❑ Trailer Court ❑ Motel ❑ Otl+er Number If living units:, _ _ Number of bedrooms--_---.. Number.... f'baths,_ --- Lot size -- f- --- --=----�s- •--- ---------- ----- 9 r.` Private De th to Water Table ______._ ft. Wafer Supply: Public syste m❑ Community system ❑ pHardpan ❑ x: Character of soil to a depth of 3�feet: Sand ❑ Gravel ❑ Sandy Loam ] Clay Loam ❑ Clay ❑ Adobe Previous Appliclfion_Mad-e,:�Yes,.❑,,,,.No LR IJ New Construction: Yes [/No ❑ FH'A/VA: Yes ❑ No !v j TION AAD SPECIFICATIONS: , TYPE OF IN5TALLA �/ No septic fank_.or c ss ool erm"tted if pubic sew tis�avgilab eiwithin 200 feet.)# f istance from foundation--`i -----~---Material_-- Septi ank: Distance from nearest wel ♦ F i ` No. of compartments - ize Liquid drpth' - Capacity------- --__-[[--(ol, # k , " Y * I ` stance to nearest lot I's e7t-5 1; � "Y Disposai�Fieid: Distac�e•from nearest w i ._. k.______ `{stariee;from foundat" r _ f_._ ___Len th of each line____ Width of trench.____._Number, lines_--------- -•-- g �� :: e th of filter material-->-_.__ii - ----___---Total length--------------------- -��` Type.o3�filter:,}aferifil? P f A Seepage'Pit Distance to nearest well___ I ____ Distancerfrom defion-___________________.Distance to nearest lot lyre_ ---- /5 Size:Diameter-- -------Depth------- � Number of pits-------- -------- --:Li ning material--- "--- -:----- -- ¢ 3 ' I - dz "Cesspool: Distance"from nearest well-_," -- Distance from founddattio--------------------Lining material________.._.___.____.___.___ � ___ ! De Dept -------------Liquid Capacity.---------------------------gals. � # ------: p ,.. Size: Diameter-------.----� -- ---�---, N � --_Distance from nearest building.-_ "_------------------------------------ (.—Privy: __.._- ---- � (. --°Privy: Distance from nearest well-__..-."--_-"-------------__--"-__._ - = ---------- - - ---- --------------------- El g nearest lot line_-___--.- '=- -- ------------- -� -------------- ` h Remoielin nd ----•-------•-----•------------ ------- —---------------- -- -- -------- __--"------ -----------"-___--_"--___-_-_-----_____-_-_____�__________________________•__ E hereby certify that 1-he ve prepared,fhis application and that the work will be done in accordance with San Joaquin Count � q y :3.4 he San Joaquin Local Health District, y ces, 5fafe Daws, and rules and,re ulations of f 9 ordinances,' y (Owner and/or Contract '�. r_ '.'. ,c - ------------------------------------------ ------------------ and o or� (Signed)- E 'c,ar' s . . ' le) ----- - (Title) -------------- = 1 (Plot plan, showing size of lot, location.of system in.relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLYDATE, APPLICATION -ACCEPT�D B --------- -------- ---------- REVIEWED BY -"". , f - DATE_------•----------------------------------------------- " DATE__.-- BUELDING PERMIT ISSUED----------- ------------------ - I -----------•--------------------•------- Alferafions and/or recommendations:_"---"_ __-."-_.___.-_--"-"_-_.-._ __ ---- ------ ------ -------------------------- __________________r __ _ _.---"__-_-_-"..__--__-_--___------_-_---_______"--____.._ - ____ _________________________________ = � -----------=------ -�` ----.---- ; --:------- -- ------------------ r-VY . Date-- -�--------- --------- -----•-----••-------------- ----•---- FINAL INSPECTION : -------------=-------- y IAN JOAQUIN LOCAL HEALTH DISTRICT 4� 1e W` 132 S camore Street 814 North "C" Street 130 south American Stre�; 00 West Oak Street Y } di, California Stockton, CaVifornia + Manteca, California Tracy, California ES-9-2M Revised 1157 f.P,CO.