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j�'►;"W ,J.,.. 1 APPLICATION FOR SANITATION PERMIT Permit No. _� "___.. 2 t (Complete in Duplicate) A Date Issued i Applica-1-ion 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. 54 . I JOB ADDRESS AND LOCATION -------Phone--4 � - i-- Owner's Name--- - -------a- -�---- --------Qom'----------- - --------------- - ---�-------------� --- Address---------. -----/- � -------- - -----------------s--------------- -----__-------------------------------------------------------- Contractor s Name ----------------- - - .- - --- --- - - -- --- -�L� - ---------------- Phone---------------------------------- ❑ Other ❑ Installation will serve: Residence A artme House Co mercial Trailer Court Mote x, Number of living units:___ Number of bedrooms __ _-___ Number of baths ___.___ Lot siie __ ___ ... _ _�1--1-. ---------•- ) t Water Supply: Public systemCommunity system Private Depth to Water Table -------- ft. Character of,soil to a depth of� 171E]eet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ es Previous Application Made: Yes E] No� New Construction: Y -,Jg No ❑ TYPE OF.aNSTALLATION AND SPECIFICATIONS: (N6%viptic tank or cesspool permitted if public sewer is available within 200 feet.) �eptic Tank:' Distance from nearest wel _�_.._.Distan e from fo n\daation---Z_1p-----__..Material---0Q 3. -G_----g�_----. No. of compartments-- ---r _____.__Size._ _ -S_ __ }Y Liquid depth_._. ___-..___..._Capacity._ ' Disposal Field: Distance from nearest well__/Y_P`'AQ_Distance from foundation----J_-(2:)-------Distance to nearest lot line---c Number of lines---------/_-----------------------Length of each line__-___--. v`_..........Width of trench---- _ ----------- >r Type of filter material. _ _ �� filter material----.�._g..4___.----Total length-----�___b ------------------------�� Seepage Pit: Distance to nearest well. ___=_vk-R____Distance from foundation-1.6------------Distance to nearest lot line__J�._-------- Q Number of pits------ Lining material_ Diameter__._ �_ ___ -----Depth_______ -15_____.________- Cesspool: Distance from nearest well-----------------Distance from foundation.---------------------Lining material--.__---__.-________--_-__---__--___. ❑ Size: Diameter--=--------------- -------------------Depth---------------------------------------------------Liquid Capacity-.--------------------------gals. Privy:- Distance from nearest we=Il ----------------- ... - --------------- Distance fro-m 'nearest building------------------------------------------ ❑ Distance to nearest lot line-------------- -------------- ------------------_------------------- ---------------------------------------------------------------- Remode- g and/or repairih (d�scribe):----- a"L ------- - ----------- ------ �_ ------------- --------------- ------ ----------------------------------T--- ----------:� ---------------------------------------------------------------------- ------------------------ --------------------------------------------------------- ------------------------------------------------------------------ ----------------------------------------------- - 1 hereby certify that I have prepared this 'application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws nd rules nd r ulations o he San Joaquin Local Health District. , ----------------------------------- ---------------------------------(Owner and/or Contractor)(Si (Signed) By:---------- --------------------------=--------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ,- APPLICATIONACCEPTED BY--------------- --------------- ------- ------------_---------------------- ---• -- ------ DATE-----`�-------------------------------------------- �. REVIEWEDBY--------------------------------------------- ---- ------------------- ------------------------------------------------ DATE _ --------------------------------- BUILDINGPERMIT ISSUED----------------------------------------- - ---- ----•-------------------------------- ------ DATE-- - --•------------ - J -----------•-•- Alterations and or recommendations_____________________ •------------ i ---------------------- .. �' -�s�.. .. _. ---------- -------- �- G — �_ ;_... ,I Q----------------------- ------------- _ � _ --__ ..- . ----------- a FINAL IJ SPNali f------------ BY: I Da e_.. ;;,�, � � ..��•QQ I NA I , 5130 Southr sf�QR'3et a mo r t orth r t �"'�t California -� Manteca, California Tracy, California t � StocktoLodi, ��... ES-9 145446 ATWOOD -.<_S- 7 440,0' .- �P - v��z — ri I i.s.s?-aA �/i:f�,)L esf® orab�,� 77,�_-'• aAL4. K