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11 � APPLICATION FOR SANITATION PERMIT -11�149 Permit No. d (Complete in Duplicate) Date issued --------------t--------- 7T k kerein described. ),,t and insta" t it t c6nstr ,1Z 16 �o - T= V made 'to the San Joaquin Local Health District for-a pelm cl Application is hereby 11 1' W. h County Or�linance No. 549, This application is made in Vp iance w� ___tf -49 rg --------------- JOB ADDRESS AN _OC.TIONPI Phone------------- ------- ---- Owner s ----71,7,AP q_ . e . I I ---- ; ..f4ftAolo, s - -- - --- ------ ---- - ------------------- i------------- ------------------------- Phone----------------------------------- I Other E3 s Name 7 Trailer-f Courf ❑ Motel o Contractor' Commercial L-i en Lot size - - ------------------------ 4_4 Residence Installation will serve �a,tm f House [I m ?_ Number De Number of livin units: Y-----Number ofibedroo 'sJg :, t 'to Water Table'Wff.licsystem [:]Ccir�munity systern'W,-frivate [] pth �arclpan 0 Water Supply' Pub t feet: Sand El Grav.el ❑El Sandy Learn E1 Clay Loam 0 0,y [] Adobe Character of soil to a depth of 3 ew Construction: -Yes ? 'rNo E]! FHA/VA: Yes � NOO Previous Application Made: Yes El. No �N TYPE OF I INSTALLATION AND SPECIFICATIONS- ,I permitted if public sewer .is available within 200,feet.) i (No septic tank or'c'essPoc -4-P �Aateriai_ & rom found -------- -P_o, e------ ---- --;y Distan 5paci -14640------- Distance from noarest -------- ---L-,qj;d dep�h_,R------�0----------- Sept' T k' ---*_size-r.7-dw---x---47 n lot line---�t�--------- cbmparfments---A.,----------- No. o . I I D_,,�a 16e to nearest nearest g —----- Distance from foundation, ...... ----------- Dis Dlsta�ce from nec ---------- 9 x fjo -_. ---- en fh of each line)-?_4--- - -- -------width of trench --- p Number of lines______-------------------- L Total length- ----------------------- %W material_/-- ------ Type.of filter rnaterial-/4 ---Depth of Vter:ma lot Distance to nearest fi 66'�n-------- --------- ;z Distance ro�n_joun ----------- 1_� Dista'Ice to.nearest e -------Depth------ Seep�6e Pit: Q - Lining material-/o Aowwesi,e: Diameter-S- ------ Number of pits------ ---------- '0 1{/, , --------------------Lining material-------- ---------------------------- Dista'-rice from nearest -ell------------------Distance from foundation --I-----Liquid CaPOci+Y----------------------------gals' Cesspool: -f -l.Dep+rh---'--.'..-----------'-.----------------------- 0 Size:I i Diameter-- -------------- 4-.-Distance from nearest building----------- ----------------- -------- -- - ---------- --- Distance from neareit well--- -------- ------❑ ---------- ------------------ ----------- Privy: 0 1 1 nearest ------------1-------------- Distancelto _2, --------------------------------�i i, -----------------w----------------i a ----------- ------------ Remodeling and/or repairing 5 ------------------------- --------------------------- --- ----------------------------- ------------------ -------- - --------------------- �-Ip --- ----------- a ----------------I-------- ------------------- . . k, . --------------------------------- ---------------- -------------------------------- --------------------------- ----------------------- ------------------------------------------------------------ -Joaquin County --------- in accordance with San ----------------------------------------------------re prepared this application-jnd.Aat the,work will-be done I hereby certify that I,hay Joaquin Local Health District. e lawi,:P ' and rules and r ulationSrrof the San, ordinances, Stat i. 1 .1 , 1 Contractor] ----------------- �j JVC4� _1C----- ----- -------- -1 eg (Signed) ------------------------------------(Title)_ -�_ .:- ---------- -- --------�-W_�4(.a. `-----"""•""'"--'----- - on rev 09 side). By:--------------------------- lot, lea anon of system in relation to wells,,k;uildings, etc-, can be plar (Plot plan. showing 61ze.10f FOR DEPARTMENT USE ONLY ------------------ i 4, DATE------------------------------ APPLICATION ACCEPTED BY------------------- ---------- ---------L------I---------------- -----------� D,6�T E--------------------------------------------------- I!, ----------- -------- ------------------------------------------ REVIEWEDBY-------------------------------------------------- DATE------------------I------------------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------- ----------------------------------------------------I------ - Alt t ns and/oreommdatigns. - -----j- ---------------------------------------------------------I---------------- --- -------I------ --------------------- ------------------------ ----------------------- ---------- -------------_-------I----------------------------------------- -------------------------------------------------------- ------------- ------------ --------------------------- -------------------------- I ----------------- ------------------------------------------------------------------- ----------- --------------- --------I-------- ----------------------------------- --------------------------I-------- ------------:------------------------------- ----------------------- ---------------- i - ------------ ----------------------e ------------- ----------- I--------------- ------------- 7---------- --------- Date_-._Y/ FINAL INSPECTION 'BY----------------------------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 814 132 Sycamore S� North "C" Street free+ 300 West Oak Sf root Tracy, California 130 South American Street Manteca, California % Lodi, cal;fo;nia Stockton, California FS—(?-2P Revised 1,57 F-P-CO.