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Permit No. ..... ti FOR SANITATION PERMIT issued ----�-' /sb pPLICATION Date (Campdescribed. A lets in Duplicated v { permit to construct and install the work herein descri e uin LocaOrdenatncDeyN°G549 t for a p !I � - p,pplica4ion is hereby made to thl ante w;h County 1 ------------------------------ - 1,cation is made in camp --------------------------------- ------ ------------- )T This app �� ,, O .JOB ADDRESS AND LOC .. --- ----------- -----------. ----• --• Owner's Name ..., ----------------- Phone-. „- � ' a Other ❑ Address-----��........ ----------- Motel ❑ - - Trailer Court Commercial ❑ u -.-- Contractor's Name--- -�J A artment House ❑ Lo{ size _---------- .. Installation will serve: Residence p Number of baths ----- „ , units: ----t--- Number of be Private Depth to Water Table ft. Adobe� Hardpan ❑ Number of living Community system ❑ Clay Loam❑ Clay❑ I Public system ❑ Sandy Loam❑ II Water Supply. Gravel ❑ ❑ ! New Construction: Yes �NO Character of soil to a depth of �t•No a� II Previous Application Made : 4 I� ermined if public sewer is available within 240 feet.) Material------------------------------------------------- TYPE OF INSTALLATION AND SPECIFICATION : (No septic tank or cesspoo p Capacity-------------""-"--” .Size------------------------•------ Liquid depth �� Distance to nearest lot line----------------- k from nearest well____--- -------D's}once from foundation,on__------"---,;'-- Se�ta compartments-- ----- No. of comp }h of each line -I ---•..Width of trench Disposal F/ield: Distance from nearest well_----------- -- Distance from fours a ,o -------•---- ----- th-_.___•------"-_-•------- / CcQ � Number of lines------------------ --------Legg i 1 Dep th of filter material............."II ---" Tota length f� ----- - J� Type of filter material--- ----- - '" ��• � " Dep#'n- ---- --'�-�-----•-- �"-_-_-_"Distance from ------foundatl°nDiame�er"_."Dist�ce to nearest lot me----------------- Distance to nearest well----- -Size. Seepa 6 Pit: gals. Number of pits:-------- --- - - - - Lining material---- ------ ------- - . Liquid Gapac,ty-- _.Linin materia_-------- ------- Distance from nearest well_- Distance from foundation--------- -- g Cesspool: ----- -------Depth-------------------- --------- Size: Diameter---------- ---- -- Distance frog, nearest building--------------------- h ❑ WellII -----------------•---------- --- - Distance from nearest ------------ ---'---------_-_----..- -'-"" Distance to nearest lot line.--------- ----- '---`, -lv�lII_ II ------------------------•_• --------------------------------------- Remodeling and/or repairing (descr�Iae)---- -- -------- ------ - -------------------'---•-=-•----•-•----•-•------•- ----•- --------------- - ------ -"---- -- - -- - -- -- ---•-------- ------------ - p Joaquin County ------------- """ r- ared this application and that the work will be done in accordance with San I hereby certify that-I have prepared ulhis a li the San Joaquin Local Health District. ordinances;State laws, and rules and reg ---(Owner and/or Contractor) �� ---------------------------- - i � . Si ned ( e). ( 9 ---- .1-. - 'n size of loocation of sys�em in relation to wells, buildings, a#c., can be placed on reverse si e. (plot plan, showing FOR DEPARTMENT USE ONLY !� r ---- --=------- DATE------ ---- .__---�--��=- ------------------- ------------------------------ --- DATE-------------- APPLICATION ACCEPTED BY------------ ------------------ -- --- - -------------- - DAT ----------------------------------------------------------- REVIEWEDBy------------------------------------- ----- - ------------------------------------------------- -------------------_--- BUILDING ---------------- -- BUILDING PERMIT ISSUED------------- ---------- -- Alterations and/or recommendations:_--------------- `" " II ----------- ........................................................ •------------- - ------ ----------------------------- - ----------- --------- --- -T --------------- -- !. -- - -----•----- ---------------- Date_-...._ ----- ----- ------ - :� FINAL INSPECTION BY•-.------- - - ALTH DISTRICT SAN JOAQUIN LOCAL HE B14 North 132 Sycamore Strest 300 West Oak Street Tracy, 130 South American Street Lodi, California Manteca, Celifamie Stockton, California ATW 00o i2rS4 -- -