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APPLICATION FOR SANITATION PERMIT Permit No. Al (Complete in Duplicate) Date Is -sued 7 1 �4_ qx, and install the work herein described. if to construct Application is hereby 'made to the San Joaquin Local Health District for a perm This application is made in compliance with County Ordinance No. 549. ------------ •7-=------------------------------------------- JOB 7� ----------------------- ------------------- -- ----------- JOB ADDRESS AND L CATION ------- /,7Z-1 - - - ------------------------------------- Phone ---------- -------------------------- --------------------------------- Owner's Name---- ------ --------- �84-' -AV-/- -- ------------- ---------------------------------------------------- Address--------------- 47to-047 - - ..S Phone.. --------------------------------- '3b 14 , Other El Contractor's Name__- --- ..... 7_0 Trailer Court 0 Motel 0. Installation will serve- Resid,�cej, Apartment House o Commercial 0 `0 ----------------- drooms Number Of baths I--- Lot size Number of living units: umber of be I *Commu 'ify system,❑ Private 0- Depth to Wafer Table'-./ -o- ff Wafer Supply: Public .system n Sandy Loam 0 Clay-Loarn El Clay C1 Ad; Hardpan 0 Character of soil to a depth o A3eef:. Sand F] Gravel [I S N 0 a - �< FHA/VA: Yes [I Made: Yes E] No New Construction:. Yes 0 No Previous Application W . . . TYPE OF INSTALLATION AND SPECIFICATIONS - N A or` c 'spool permitted if public sewer is a�ailallalq, within 200 feet.) es -------------------- (No septic +a 0 - Distance from,foundation ------------- I ------ Material --------------- ----------- Distance from nearest well--------- -------- D 6 _' Capacity.. --------- I ----------- eeW;016' Size ---------------------------------- Liquid de��h ------- - --------------- - No. of compartments- ------------------------- I i nearest lot line_--,.-:---------- V� q �.Distance from foundation -------------------- Distance to , - eld: Distance from nearest well__-._--------- _Width 9f trench -------------------- Nis Length of each line-- ------- ---------------- Number of lines -------------- r ------------------- : ------- Total length--------------------- --------------- ----- Depth of filter material ----------------=---- of filter material"------------------- _-Dista " f . foundat;on__.AS .........��--------Deian59 to nearesf"lbt line_ '-Distance to nearest 'c' ----------- a e Pit: ' al -,._._7 t_,S�,e: Diameter_ -Se -Lining material / ------------ L Number of pits-- . r ----------------- Lining material --------------------------- ---------- Distance from nearest well_.-"-- ---- I ---- Distance'from founclation_' - . ---------- Liquid Capacity -_--.--._-__-------------".gals. - �_esspoo�:Depth------: ------------------------------ -------- ----------Liquid F1 Size: Diameter------ --------- - Distance frorn;nearest building---------- ----------------------------- -- Distance from nearest well----------------------- ------------ -------------------- ---------------------------------- ------------------------ ---------------------------------- ❑Privy: Distance to nearest lot -line --------------------------------------- 4 -------- #0 1 _414, --------- ----- e4z.� ------------------ ------------ ring (describe): ----- _4 Remodeling and/of rppai, 0" ------------------------------------------------------------------------------------------- - 1 0 ----------------- - ------ __0 ------------------------ ----------------------------- _ 7 ---- - ------- - --- ------ ------ �> --------------------------------------------------------------- --------------------- -------------- I ------------------------------------------------------- ----------- -- i ------------------- 6 ------- ------------------------------- I --------- -------------------------- --------------------- -------- at have prepared fl�� lication and that the work will be done in accordance with San Joaquin CountY I hereby certify g" rules tions f the San Joaquin Local Health District. ordinances, State lawi, and reg I(Owner and/or Contractor) 'o v, ----------- V, -- ---- (Signed} ---------------- AE�1_ ------------ ------------ ___� ----- ----- Title - — --------------------------- By ----------- ------ ------- ------ in relation to wells, 41dingst etc., can be placed on reverse side). IPIn+ Dian, showing sire of lot, location of system "I APPLICATION ACCEPTED BY-_---------- --------- REVIEWEDBY----------------------------------------=-------- 6- BUILDING PERMIT ISSUED ------------ : ----- -------- -- A tions: ------ FOR —DEPARTMENT USE ONLY ------- DATE---------- _ �- DATE ATE---------- DATE --------- 1 --JA -------------------------- --------------- ------------------ ------------------------------ ---------------------------- DATE - - ------------------------- I ------------------------------------------------------- I ------------ . : *----------- Alterations ----------- Alterations and/or recommen a -------- I ---------- ----------------------- ------ --------------------- --- ----------------------- --- ------------------------- ------ ------------------------- ---------------------------------- ------------------ ------------------------------------------------ --------------------------------------- -------- -- --------- --------------------------- -------------------------------------- ---------- ------------ � - .1 -------- ----------------- --------------------------------- ------------------------- --------------------------------------------------------- ----------------------------- !. ----------------- -------------------------------------- ---------- r --------------------- --------------------- ----------- ------ ----------------------- ---------- ------------------- -- ----------------------- ---------------- ------------------ ----------------------- ------- ------ N FINAL INSPECTIO' Y -- ------- ------------ -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 300 We0 00k Street 132 Sycamore Street Tracy, California 130 South American Street Manteca, California Stockton. California Lodi, California F-S—q-2M Revised }-57 FT.00