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Permit No. L, -�'�,� ' APPLICATION FOR SANITATION PERMITg ' .i? (Complete in Duplicate) Date Issued t made to the San Joaquin Local Health District for a permit to construct and�y'nstall the work herein described. Application hereby ( � (--O�1 f This application_is.made in.c� ian,�ce with County Ordinance No. 549. t - 701�54___ !� JOB ADDRESS AND C T _ t ------ - -- one--------�_`&_7��----- Owner's Name__. -- .---- ----- ---- ------- Address ---- g (o--------- Contractor's -----,., way----- Phone--- .---- Contractor's Name_______________________ Motel ❑ Other [4r- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trai;er Court ❑19 Number of living units: �N Number of bedrooms _..r Number of baths _-- Lot ------------------------------- Lot size . �Public stem system ❑ Private Depth to Water Table Water Supply- ' y ❑ Community y � � Adobe� Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel 1-1 Sandy Loam El Clay Loam ❑ Cla y ❑ Previous Application Made: Yes ❑ No g_New Construction: Yes 9 No ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -------------M ate r i a s -- - - - - - --- ----•-- -- Septic Tank: Distance from nearest 14_ -_---p Distance from foundation--6 anon_- Ca acit -- - No. of compartments- Size_. __/ 1l�-:___Liqukd �epth__.,, tp--------------- p Y 7 ' ---------- - -_---_.__---Distance to nearest lot line__a---- Width of trench --------------- --�i�..._.Distance from foundation__ _ Disposal Field: Distance from nearest well. _ Length of each line___7S - Number of lines------1 ��- - g ----> T'r- . C-4--Depth of filter material_.._l �_._----...Total length__ rf- --------- -------- Type of filter material-�-_}."____-� � 11 � --__.fassta/,j to nearest lot line_��.------ Seepa a Pit: Distance to nearest well__. 7-___._Distance from foundation__ _.-- e/ De fih._ _._ ------ ---------- Number of pits---.�----------------Lining material-___��'��8 --Size: Diameter____ -____-_--__-- p ------------------- ---- Cesspool: Distance from nearest well________________ Distance from foundation_------ Liquid Cat acit ---------gals. ❑ 5ize: Diameter-------------------------------------Depth_.--------------------------- -------------------- 9 Capacity --- - ---- _______--Distance from nearest building Distance from nearest well---------------- -------- g -------------- ---------- Privy: ------------------- ❑ Distance to nearest loft line--------- -------- -------- --------- ---------•--------------•--------- ---------------- ---- ----------------- -------- Remodeling and/or repairing (describe : _-- - ---•------- -----•- ----------------- ------- --I;w-- __;11-- i - q Y J . --- ------------------ -- --- - - - ----------- ----- -------- --------- -- - ---------------- ------- - - --------- ! her y certify that l have prepared this applicati and that the work will be done in acco once with San Joaquin oun ord'manc , State laws, a an lotions of th San Joaquin Local Health District. ---- O ract j ! -(Owner a /or Cont or ____________________*1.4_14 - 0. (Signed) ------ - � --- - - ---- ------- -{Tit _.__ �-- ----- •---•-- -.-.-�--- - ------- ------- --- fe}_ __ BY� = 11 - ----- -- --- --------- (Plot plan, showing size of lot, location of system in relation to we] , buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. — ------ ----------------------------------------- DATE --------------------- --- DATE -- ------------------------------------------ REVIEWEDBY------------------------------------- ---------------------------------------- -- ------- - BUILDING PERMIT ISSUED----------------------------------------------------- - ----------- --------------------•---------- - DATE--�---�--�------- --•-----�-------------�-�--- ---------��--- ------------------------------------- Alterations and/or recommendations:________________________. -- -------- --------------------------- -------------------------•--------------I-------- --------------------- ------------------------------------•---•--------- -----------------------------•---------------------- -----�---- BY Date_---. f - FINAL INSPECTION ..---- --- - -- -------- 9/ SAN JOAQUIN LOCAL HEALTH DISTRICT i32 S camore Street 814 North "C" Street 130 South American Street 300 West Oak Street• Y Tracy, California Stock+on, California Lodi, California Manteca, California y, FS-9-2M 10-52 Revised W-2100