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1l.N' Permit No�Z/----- APPLICATION FOR SANITATION PERMIT ` �t y. (Complete in Duplicate) Date Issuedol�Z- --5- to the San Joaquin Local Health Disfirict for a permit to con trudf and install the work herein described. Application is hereby made This application is made in complWnnce.with County Ordinance No. 549. JOB ADDRESS AN LOCATION .'�_�--�•'Y`---- '�-�`�'=!-�---�•--��''-----�-------�-Y��M� -I"��!, �-�_q�,;<- -------- - Owners Name- -- - ' 3- - --------------- ---------- ---- ' - . Address----------------------- - - �---- - ----r°�-'�'---�---•-- Phone---- i Contractor's Name ----- - - - Commercial Trailer Court ❑ Motel ❑ Other ❑ Apartment House ❑ ❑ ' Installation will serve: Residence ® p J� Number of living units: -f-_-- Number of bedrooms _Z-_ Number of baths _ .----_ Lot size ---- -- Water Supply: Public system ❑ Community system ❑ Private S Depth to Water Table o'�_l ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam 29, Clay Loam El Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet. � '1-c' �d�-P 1Q'r'ti`^^'3vlateria---- -- ----- -- Septic Tank: Distance from nearest well--_-�A-_---Distancq from,foun�ion__- - Ca acit No. of compartments._,---_ --- -Size -�__ - Liquid depth p Y /v_1)1_4*.Distance to nearest lot lin i�� I Disposal Field: Distance from nearest well -------Distance from foundation-�: " Number of lines__-.------��---- _ Length of each line_-----�- j�---------Width of trench-_--------------J--------® De th of filter material--- -�_---- 9 ' � � -----�Total len length------ -- �-- ---------------Type of filter material-- - - --- p Seepage Pit: Distance to nearest well----------------------Distance from foundation to nearest lot line---._-- . _❑ Number of pits-------- Lining material-----------------------sizeame . --- ---Cess ool: Distance from nearest we}I---____-_ Distance from foundation--------------------Lining material---- ------------- els. pT -, _Li Liquid Capacity -•---g .- Sizc: Diameter----------------------------------- -Depth--------------------------------- q p Y -- Privy: Distance from nearest well----------------------------- Distance from nearest building-------------------------- - Distance to nearest lot line------------------------ - . � - ----C -------- ] Remodeling and/or repairing (describe].--- ----- - ----------------------------•-------------------------------- ---------------------- -------------- 1. ---177.1-- ------------------------------------------------------------------------------------------------•---------------------------------------------------_---- - I hereby certify that I have prepared uthis application the San Joaquin h work Heawill l Health nen accordance wit h San Joaquin County ordinances, State laws, and rules a 9 - ' (Owner and/or Contractor) s (Signed)---------- (Title) ------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side. FOR E ART ENT QS ONLY APPLICATION ACCEPTED BY--------- -- ---- DATE------ � ' -------------------- ----------------------------- - DATE BUILDING PERMIT ISSUED--------------------- REVIEWED BY----------------------------------------------------------- ---------------------- --- ---- ----- = DA -- Alterations and/or recommendations:---------------------------------------------- ------------------------------------------------•----------- ! --- --------------------------------------------• --------------------------- ------ -------------------------- ---------------- ----------------------------------------------------------------------------------------------- - kDate----------- --- --- --- FINAL INSPECTION BY-------------------- --- -- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 30D West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y' r5-9-2M 10-52 Revised W-2100