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FOR SANITATION PERMIT Permit No. .._7,ff - APPLICATION �l� " l" (Complete in Duplicate) Date Issued ______--_- /. Applica{ion is hareby'made to the San Joaquin Local Health Distr'sct for a permit to construct and install the wor� l}e��n dgssccribed. This application is made in compliance with County Ordinance No. 549. O�✓ ce�� e s r L ------------------ • ----------C' �_�------ -`-` .' re JOB ADDRESS AND LOCATION-- --------- Phone. A4 tic h 19 d a ---- --------------------- ----- --•-----f�-----...---------------•------------------------•-•----------------------------•-------------------------_------------- Address----------- ------------- Phone. LAG.................--- •----------- --- Contractor's Name------- ----�-1�_�-�-,�--�--------:��- " r Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ --- Installation will serve: Residence �ra;partment House ❑ ej r Number of living units: -t----- Number of bedrooms ----_L-Number of baths .___�- Lot sae ----7_4 ----------------• Water Supply:` Public system 5Communitysystem' ❑-=Private []� Depth'} a al namable -Cla- ft. Adobe[§--Hardpan ❑ Character of-soil to a depth of 3 feet: Sand E] Gravel F`1Sandy Loam [jClY [Iy Previous Application Made: Yes E] > No [ "'New Construction: Yes;^❑ No [ �' TYPE OF INSTALLATION AND SPECIFICATIONS: �. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weiV-----------------Distance from foundation-------------------Material---------------.-".------__.__"-.___..____-_""- - _ _. -4 Li uid depth--------------------------Capacity----------------------- r 1-5/4,1rjNo. of compartments_ Size_____________ ci // "" line---tion---------.------- --Distance to nearest lot line----------------- Disposal ----------------Dis osal Field: Distance from nearest well -------------- Distance hounda4 Width of trench""-.""--_""._-_- ..--_ -_--- ❑ �,1�r.Sl•,NJNumber of lines---------------------- q -- Total length Type of filter material .,.--------- ----Depth of filter material-----.-----------:-- f g - (}Ne-'_Distance from fouridation_"-_-�-v_____-Distance to nearest lot line ._.`f______-_-- r Seepage Pit: Distance to nearest well. -- �,. tY( Size: Diameter �r Deptln_.._. s Number of pits.,.._.../"--_-___-_.-Lining material." - t Cesspool: Distance from nearest well___._____.____Distance"#torn foundation--------------:..... Lining materia_:____-___.____"--------�-�--""-als. --De th---------------------------------------------------Liquid Capacity-------------------- 9 Size: Diameter-- - �" ----------------- F Privy: Distance from nearest well...--..-__"----------------------- ------ =Distance from jnearest building__-_--______.__--____ " �. ❑ r Distance to nearest lof line..- ".....- --- - , f Remodeling and/or repairing (describe):---- " �!! _�_ _dL------------------------ ------•------------ ----- ----------•--------------------•--------------- ------------•-- - ------------- -1 --•--------------•--•------- "________________________________________________4. I hereby certify that I have pdr egulati ns olf the San Joaquinthe workcalHeawill l be don cin accordance with San Joaquin County ordinances,.State ws, and esan f 1 f// rand/or Contract ne (Signed)_ l ay: Xowing _ --------------- {T�t e_ 4(Plo# plan, sze of lot, cation of system in relation to wells, buildings, etc., can be laced on reverse side). .1 FOR DEPARTMENT USE ONLY -------------------- APPLICATION ACCEPTED BY �,�_. DATE---- = -- --------------------- f REVIEWEDBY----------------------------------- -------- ----- DATE-------- - -----------•--- ----•---�----•---•---•------------ ------ ---- -------------------------- BUILDING PERMIT ISSUED---------------•----------------- :. _ Alterations and/or re ommendations: .---.- ----------------------- = `- -------•----------------------------------•-------- ---------- ---- ---••------------------- --- ------------- ---- ---------------------- = = = --------------- ----------------- ---------- ---------------- -----. ----- ------------ sDate.-------�-- ---�-.. ..� ------ ----------------•---•--- FINAL INSPECTION BY._._...__"___-- -------�----------- ------- ---------•--- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 .South American Street 300 West Oak Street Trac California Stockton, California Lodi, California Manteca, California Y• ES-9 14s44e ATwoou _ -