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'y APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a p6rmit to construct and install the work herein described. This application is made in compliance with County Ordinanc-e—No 549 JOB ADDRESS AND,L 'TI -- ----- ---------- -- -- -- ------- ---------------- --------- ---------------- Owner's Name--------- -------- --- - ---------------- - --------------------------------I------------------- --.__ Phone � ---- - - Address-- ---------------- -- --- ---------------7---------------------- Contractor's ----------------K_ Contr ctor's Name-------------- -------- - -- ---- --- -------------------------------------------------------. Phone------_- ............. 1 -It Installation will serve: Resi, Apartme ouse E] Commercial [-] Trailer Court E] Motel [j Other Number of living units:,5�--) 7 --- Number of beclrooms4� e::5-- Number of baths - Lot size _' i �------ ----------------------- Water Supply: Public system El Community system [I Private Depth to Water Tab] Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam [] Clay Loam E] Clay E] Adob>e Hardpan E] Previous Application Made: �Yes Ej No New Construction- Yes) No E] TYPE OF. INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- I f (1Y -------D' t f anon_ -------Mat ---- ------------------ g_�q rl is Ze a Capacity.__5i ----------- No. of compartment—_.._-.._..______size ..�� 0_u __:___Liquid x Disposal Field. Distance.from Ir o m nearest well...._ Distance from foundation-------�D Distance to nearest lot line_____- -------- E1 Number of lines----------------I...__..__11.......Length of each line-----_-------1 -:---.._.Width of trench-------------��Y------------------- Type of filter i If er maf eria I'- 1/i--- -Depth of filter materiaI------ I-----Total length---------/0----------------------------- See-page Pit: Distance onearesf well- ------11D ance")MfVndation_ ........Distance to nearest lot Iine__._jr,_"__, ,a ------------- Depfk__ XZ7... Number of pits----.'/----------------Lining material . ..... -.--.Size: Kiameter-_-.7-, 2-Y --- d r foundation____-._________- &Nsp o I- Disicincel-from nearest well_______________ Distance from foundation - ---- - -------- Lining material__..____....__-____._________.______-- El Size: Diameter-------------------------------------Depth---------------------------- ------------------------Liquicl Capacity- - ------------------------gals. Privy: Distance from nearest well------ __-------------------------- -----------Distance from nearest building.-___...__________-____________.___._._. El Distance";o.nearest lot line----------------- ----------—------ ------------------------------- ----- -------- ----- ------ ---------- ----------- -- .0 Remodeling and/or e ain -------------- --------- ----------- ------------ -------------- -- --------------------- -------- ---- ------------- - - ------------- ------------------------------ ------------ --------- --- -- - - -- ----------- ----- ----- - ----.------------------------------- ----- --- ------- ------- 0, ----------------------------------------------------------------------•••------------•--_.....----------------------------------------------------------- --------------------------- -------------- ----------- ------ I hereby certify that I 'i. ave epared this application and that the work will be done in accordance with an quin County ordinances, Stat?-Ila, and �ul n ogulafions of the San Joaquin Local Health District. (Signed)----------- - ----- --- --- - --- ----* --------- ------------------- Ow or Contractor) By---------------------------- ---------------------------------------------------{Title --- -------------- (Plot Plan, showing size of t, cation of sysem in to w6lls, buildings, etc., ced on -r- FOR DEPARTMENT USE ONLY ------------------------- DATE------------ ------;5� APPLICATION ACCEPTED BY----- ------ --------------_................. ------------ 11 IV S � REVIEWEDBY----------------- -------------- ...... ----------- --- ------------- ---------1--------------- ---------- ------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED IM --------------------- ------------- --------------------------------------- DA.TE------------------------------ ----------- ----------------- Alterations and/or recornirgenri� dations:-------------- ------ r —------------- -------•----------------------------------_11K--- ---------_---------- 21-P...... ----------- Ii i--------J'y--------------- - -------- -------------------------------------------------------- ---------------------------------------- -----------I.....'?------rjo------ 4---------- ---------------------------------------------------- --...._.__.I-----------••--------- �---------------------------------------------------- -------------------------- ------ --------it--------------------- ----------- --------------- ------- - -- --------------------------------------------------------------- ---------------------------------------------------------------------------------------•--------•-•---------------- I FiNAt ------------------------------------------------------------- FINAL INSPECTION BY:-!--- --------------------------------- Date------- - -- --- ----- ------- ----------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Striet 132 Sycamore Street 814 North "C" Street Stockton,'California Lodi, California Manteca, California Tracy, California ES-9-2M 14544r,ATWC10D 12-54: I