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11 ?!, Wt APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicafe) Dara issuedtssued VI-(e A- plica-�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install work herein described. This application is made in compliance with County OrA"_9n No. 549. ------------------ --- JOB ADDRESS AND-lflfft-A .... .. JION... Owner's Name. -------- - ........ Phone--- me-------------------- ------------------------------- Address......... ...................... ------ -- -- -- ------- ------ I - e__ - -- �g------------ ----------------------- Name-_- �,cc---------- ph 0 �- � Installation will serve: Resid nce Eq-_"Apartment House El Commercial ❑ Trailer Court E] Motel [I Other F] Number of living units: ____/. Number of bedrooms __Number of baths _/--- Lot size ----------------- Water Supply; Public system �ommunity system El Private 0 Depth to Wafer Table Character of soil to a depth of 3 feet. Sand [] Gravel F1 Sandy Loam El Clay Loam [:] Clay [:] Adobe 2--Hardpan ❑ Previous Application Made: Yes E] No (�ew Construction: Yes E-;No F-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ptlic S 194 er is available within 200 feet.) Septic Tank: Distance from nearest well#_i?W__Distance from founclafion__./��---Material-- ---------------- No. of compartments.2----- -----------Si,e,_� from " A Liquid depfh---.5_Z1_I. a ci ------ ----- e ...... ----- ---------- Disposal Field: Distance from nearest-well/7-!_ -----Distance to nearest lot line_______- Number ine-------- Number of lines___:_,[__________ Length of each line-_,45-0---7-------------Width of trench.Z� ----------------- C pa ty e t Type of filter m Depth of filter - ------Total length-------------- 17'47, material Se ge, if: Distance to nearest well_____ ----Di ce from nclatic, --- ._.___.Distance to nearest lot line-____._. _ Number ine-------- Number of pits-------- /---------Lining m 6 a e: Diameter...........7�7........'epth-r... 2--.e-�------------- QQ - io te S isfan Cesspool: Distance from nearest well_________________ , ce fr ounclation--------------------Lining materia!__.__________-___.____._.______..._ F1 Size: Diameter----------------- ---------------------Dep ---------------------------- ----- --------------Liquid Capacity----------------------------gals. Privy: Distance from rearest well--------------------------- ----------- ---------Mstance from nearest building---__...__________________.-----__-_-. `�.1 ❑ Distance uilding----------------------------------------- Distance to nearest lot line---------------------------------- ----------------------------------------------------- Remodeli and/or ml��&�r;,n=e --- ---- --- -- ------- - 6 --- - no r_I......I-- ------ ----------------- ...... --------- - ------ ---- -------- ----- --- ------- ----- -----1-k------- .............4.::5;!7___ ---------- ---/I--- -------------------------------------- --------------- -- -----------------------------------------i------------- ----------- -.1----------------------------------------- ---------------------------------------------------------------------------------------- I hereby certify that I have pre, ared this application and that the nr'k-OfiRe done in accordance with San Joaquin County te uin L df Health District. I I N TrC/T ordinances, Sfa w , ands rules a regulati ns of fh!��n Joa ��,R �7 - (Signed)------------------ ---- --- ........ - - --- ------------------------ -- -------------------- By:---------- ------------------- ---_----------- ----- __. ez_�C4_ By:----------- - --- ------------------------------- - ----- - --- ----------- ----------- —------------(Title)---6� ---------------- ------------ (Plot plan, showing size of lot, location of em in relation to wells, buil ' gs, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- m--------------------------------------------------------- DATE--------------- _ REVIEWEDBY---------------------------------------------___-n�_ -- ---- --------------------------------------------------------- DATE--------- --------------------------------------------------- _-2: BUILDING PERMIT ISSUED-------------------------------------- ------ DATE------------------------- ----------------------------------------------------------------------------------- Alterations and/or recommendations:---_.... -•-------•----••----- iI----------------------------------------------- ---------------------------------------------------------------------------------- -------------------------------------------------------- ---------- -----I------------------------------------ ---- ---------- ------------------------------------:------------------------------------------------------------------------ ----------------------------------------- ---------------------------........ ------------------- ................ ---------------I-------- ------------I----------------------------------------------------------------------_-------------------------- -------------------------------------------- ------- ------------------- I----------------------------------------------------------------- -------------------------------------------- -------------------------------- .. j FINAL INSPECTION BY:............. ..... ----- ------ Date -- -- -- ---------------------------- 4-------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street (32 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWQCD 1Z.54