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PERMIT Permit No.�<--- 3. 7 APPLICATION FOR SANITATION (Complete in Duplicate) Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AND L CATION__..��--"r---- ------- --= •- ---- - r '.� I - -- Phone------------•-----------------•----- Owner's Name----------------•-----1- --7 - --------- ---- ----------------------------------------------------------------- - e . -------------------- ------------------------ Address------------ on Ph ' Contractor's Name------_�./.- Installation will serve: Residence Apartment House El Commercial E] Trailer Court ❑ Motel [3 Other El Number of living units: ___1 Number of bedrooms _�� __ Number of baths __I --- Lot,size��---�f 0a------•---- ----•------------•- Water Supply: Public,system Community system L] Private El to Wafter Table -C ft' Adobe Hardpan [I Character of soil to a depth of 3 feet: Sand F] Gravel ❑ Sandy Loam-D ' Clay Loam Ely ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t y n_ - Materi�al_! __ %_ st weilJcp fromfoundafio - -� Distance from neare ____ --_ '?Liquid de h Capacity 4 Septic Tank: No. of compartments-----.-�------------=Sizea4 X24-------.Distance to nearest lot line_______0___- Disposa/Field: Distance from nearest_ well_________________Distance from foundation__________ �� Number or lines__________ �_`r Length of each line_ R Width ofrench -�/'�� Type of filter material_r✓_� -_ --=Depth of filter material-___._- _----►---=Total length_________________ ____________________ �Q:__-__..Distance to nearest lot line_ ....-- Seepage Pit: Distance to nearest well________ __________Distance fro foun ation�_ . Number of pits Lining material �'- Size: Diameter ` -Depth- Cesspool: Distance from nearest well.----------------Distance from foundation.. ------------- material___________________._--_._____-__-.-. Liquid Capacity gals. 1 ❑ Size: Diameter--------------------------------------Depth------------------------------ ---------- ------ g p y----•--------- Privy:' Distance from nearest well__-_____--_____--____- Distance from nearest building------------------------------------------ - � - -----------------•-------------•------------ --------- ❑ Distance-to-nearest lot ine____-_-=--------------- --- ------------ ----•--------------------- ----------------•----•-------------------------•-------------------------------------------------•--•--------------------- Remodeling and/or repairing (describe):__-______.___________._- ---------- ----------- --------------------- ---_----------------------------------------- --------------------------------------------- ---------------------------- ui be I hereby certify1ha.l have espaepand red this ns application the Sand that Joaquin work Heall+h Disne in accordance with San Joaquin County ordinances, State -- ----------- - gnd/or Contractor) S� ned _ - -- -t --`-------- ------------------------------ (Sign( 'g 4– ed) - (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 DATE------------ r- �} 7 APPLICATION ACCEPTED BY------------------------------------------------------- --------------- DATE -...__ -�1__.----------- ---•------------------ REViEWEDBY--------------------------------- ---------- --------------- ----------------- --------- - --- DATE------------------------------------------------------------- BUILDING PERMIT 1551JED----------------------------------------------------- --------•-----------•--- ---------------------- Alterations and/or recommendations:-----------------------------_--------------------------------------- ------- q -- ------------------ -r/ �"� .�` --------------- 1(:j/1 -- ------------------- FINAL INSPECTION BY------------------------ - =' ` ` - --- Date---------------------- -q-- ------- -'------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca, California Tracy, California Stockton, California Lodi, California ES-9-2M Revised W-2100