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LOCFOR SANITATION PERMIT Permit No. 6r (Complete in Duplicate) Date Issued ---------- 0 f to construct and install the work herein described. 's- Joaquin Lo t Applica i --Is "ere5y made to the Jan cal Health District for a pernii ---This_application is made in complian' With unty Ordinance No. 549. 2-'7 H1.44L( 1�-V Z -7 -161 1 ------- --- ---------------- ---------- JOB ADDRESS kND LOCATI - -- ----- ------------ --- ------------------- ---------- flo ------ - --- ---- ---------- _d ------ - Phone--- .1t .5-0--- .60 ------- -- -------------------- 1// ------------ --------- - ------- Owner's Name----- ------- -- -- --------- ------------- -1------- -----------------------------------------I-------------------------------- --- ------------ ------ ------------ -- -------------- _------------ Address-------- ----------- Phone----------------------------------- Contractor's Name__ ----------------—-------- ------------------------------------------------------------------------------------------- rD I Installation will serve. Residence ��Apartmenf House [I Commercial 0 Trailer Court 0 ote1 E❑]r Oth?C, J Number of living units: --- Numbe [:1 Community of bedrooms ----!-- Number of baths -1— -- Lof size - -- - ----------_-- Water Supply: Public system CommunityifY system 0 Private VDepfh to Wafer Table ________'ft. Character of soil to a depth of-3 feet: Sand El Gravel El Sandy Lo Clay Loam La"Clay [] Adobe ❑ Hardpan 0 Previous Application Made: Yes 0 .No Rf New Construction: Yes ; No E] FH.A/VAt Yes E] No [I TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet) (No septic tank or'cesspool permitted if publ*�c sewef is /A ------ ------- Se ank- Distance from nearest well___ ff�__ isfan_qe frog fo afion- Y----------6�--- ---- ------- A9_ Capacity_ 4... No. of compartments---------?14--- sir-11-Y1-K---------m---Liquid 0ep,fbj1_,___4T ----------- )11*'� Distance to nearest lo i ---------- P��, -P r f I Dis I Field: Distance from nearest wellZ_6�Distance from founclafion-1 ---7------- — q .0 0- ------------------- p Number of lines Length of each line____-______?i� j-----Width of trench - ___X 1 -b.pf filter material-------IT--------Total length_--_ - ----------- Type of filter ma r Distance to nearest lot line__________.______ N Seepage ine----------------- Seepage Pit: Distance to nearest well--------------7--------Distance from' foundation------------------ --------------------------------- Number of pits----- ---------- ---Lining material---------------- i.--..Size: Di6mefer____- -----------.Depth ❑ ------------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material _gals, Size: Diameter------------------- -----------Depth-----------------------------------------------------Liquid Capacity-------------------------- El Privy: Distance from nearest well______.___---------------------------- ---------Distance from nearest building---------------------------------------- -------------- El Distance to nearest lot line__.___________________________------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------- --------------- ------------------------------- ----------------- ---------------------------------I---------------------------------------------------------------------------------------------:-----------------------I--------------------- - ------------------------------------------ ----------- ----------------------------------- ------------------------ --------------------------------------------------------------------------------------- --------------- -------I---------------------------------------------------------------------------------------------------------------------......... ....r--------- ---------------- - --------------------------------- ---------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State laws, and rules and regulations of the SanJoaquinLocal Health District. (Signed)_jAP,_-�__ -------W-- --------- ----- ---- --------------------------------------------------------- _______(Owner and/or Contractor)----------------------------- 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 --------------------------------------------------- APPLICATION ACCEPTED BY --- ---------------------------------------------- DATE.0- DATE_--:rf------------------------------- ------------------ REVIEWED BY_ DATE-----�iZC------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- ---I---------- --------------------------------------- Alterations and/or recommendations_______________________________________------------------------------------------------------ -------- ---------------------------------------------------------------...................-------------------------------------------------------- ---------------------------------------- ------------------------------I---------- --------------------r--- --------------------------------------------------------------------------------------------------------------- ------------------------------------------- - ----------- e .'/*------�--f--------- ------------------ ------5�;?------------- - FINAL INSPECTION BY---------------------------------------------------- ------------- - ... -------------------- --------------- ------------------------------- U. e---- SAN JOAQUIN LOCAL HEALTH DISTRICT 30D West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y, ES-4-2M Revised 1.57 F,P.CO.