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Permit No' .5 7.� APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date issued �pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the.work herein described. 0 1P Ordinance No. 549. This application is made in compliance with County -------------- ----------------- JOB ADDRESS AND LOCATION----------- ------- -,ff z(------ Phone-----!;?� -------------------------------------------- -------------------------------------------------------- ------ Owner's Name------------------------- --- Address------_----------------------------------------- -------- Phone------ -------- 41� ---------- Contractor's Name--------------------------------------------B----- ------I Motel [] Other E] Installation will serve: Residence JA Apartment House [-] Commercial ❑ Trailer Court [I lo- I ----------------- Number of living units: J----- Number of bedrooms _ - Number of baths __1----- Lot size Community system El Private fff Depth to Water Table ft. lou-1--li Water Supply: Public system ❑ Clay ❑Loam El Clay ❑11 Adobe, _ Hardpan Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam 0 Previous Application Made: Yes 0 No .M New Construction: Yes [] NoE] t& TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) (No septic tank or cesspool permitted if public sewer is I Material--------------------5----------------------------- Distance from nearest well-----------------Distance from foundation------------------- ci S tic Ta k. -Liquid depth-------------- CaPa' +y----------------------- 0. of compartments ------------------- ----------------------------�__ I ---------------size 0 t _)ot line-------------- Loy�� from nearest we�1,6'0-4—-.Distance from fouiTda+i0n_fk1P-------------Distance to nearest --- --------i - n ------------------------- Disposal Field: Distance -------------.Width of fre Number oir lines___.--j.i-------- Length of each riai-11.............Total length_- __ -- --- -------- 1� -Depth of filter maie I ? F _1--Y line"-._ Type of filter maferia ----------t - I 'd fion__�P--' ------ f m foun a -----------Distance to nearest lot Distance to nearest ell /00" t w Dis ance �c ....Size: "3neter_ ----------------------- fJ Seepage Pit: r' of pits-----I---------------Liningterial-If. ... . Dia ----J.=5----------De Numbe ma -------------------- Distance from nearest well-----------------Distance from foundation.-. --------- -------gals Cesspool: ----Death_ --,A------------Liqu;d Capacity-------------------- ❑ Size: Diameter------------------------ ------- I------ tstance from nearest building------------------------- -- - Privy; Distance from nearest well--------- ----------r ----------- D' ------------------------------------------------------ ------------------❑ ------- Disfance to—noarest-lot line........ _.Zf� ----------------------- _?------------------------------------ --------•----------------' -------------------------------------- Remodeling and/or repairing (describe}------------------------7- -------- 1. -- ...---------•-------""--- -------------------------- ------ I-- ----------------------------------------------------- --------------- ---------------------------- -----•--------- ---------------------- ------------------------------------------------------------------------------------------------------------------- --•----------- ---------------------------------------------- ---------------------------------------------- ---------I------------------------------------------that__t-h Awillbe n-e in-_accordance w i th S an'Joaquin County I hereby certify that I have pr4ared this application and ordinances. 5—ai'ela, , and rules and regulations of the San Joaquin Local Health District. 7 .) Contrac'tor) -------- ------------------------------------------------- . cam (Signed)-----------V -- --------- _1�----------I-------------- -:: ---wells,------------------------------------------------------------ ------------------ ---- -- -I----- - ---------- --------------------(Title)----C_s - (plot plan, showing size of lot, location of system in re to wells, buil n9s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE ----------- ----------------------------------------- APPL CATION-ACCEPTED BY--�--- ------------------------------- ---------------------------------------------------------- DATE--.E��------------------------------------------------- -f----- --------------------------- -------------------- V\ -------------- ------------- REVIEWED BY-------------- --- ----------- DATE---------fjr-------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------- --------- ---------------------------------------- Alterations and/or recommendations----------------------- --------------------------- _-------------- ---------------------------------------------------- -----------------------4�_:----------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- ------------------I----------------- ----------------- ------------------------------------------------- ---------------------------------------------------- -------------------- --------- --------- ------------------------------------------- --- ---------I---------- ------------------��---�-- --1-4-----I-------- ------------------------------------------------------------- -------- --------------------------------- Ip7 j Date------ ----------- FINAL INSPECTION BY:-------------- -------- -- ---- ------- --------J---P------------- --------------------------------------------------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 sycamore Street. 814 North "C" Street 130 South American Street Manteca, California Tracy, California Sfoek+on, California Lodi, California E5-9-2M 10-52 Revised W-2100