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No. APPLICATION FOR SANITATION PERMIT Permit / 16.7.0..3 {Complete in Duplicate) Date Issued --- work herein described. IA� atji hereby made f( pt 5 01, s co �,Vl� Ap I a o s hereby made to the San Joaquin Local Health District for a permit to construct and 'install the This appi ation is made in compliance with County Ordinance No. 549. AT ON ------------- ------ 7---- ----- --- -----Vho hone ---------------------------------- JOB ADDRESS AND LOCATION---- - -- --------I----------------------- j/4_1---------t_1------------ ------------------; Owner's Name------------------------------ ------------------Tz��------------- Address----------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name----------------------------------- ---------------------------I ------------------ ------------------------ Phone----------------------------------- will serve: Residence 81lment House 0 Commercial [] Trailer Court [3 Motel E] Other F1 InstallationNumber of bedrooms ----t Number of I baths Lot size ... Number of living units: / r p—th to Wafer Table -------- ft. Wafer Supply. Public system F] Community system 0 PrivateoErcr( Character of soil to 6 depth of 3 feet. Sand E] Gravel 171 Sandy Loam ay Loam 0 CI1Y 0 Adobe C] Hardpan [I Previous Application Made: Yes [] No 6t551VV_ Construcfion- Yes l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publi sewer is available within 200 feet.1 1 Distan a fro ou d ' 10-r-----MItsiripi----------------------------- ------------ Cg� _ ICapacity__--- -- -A- ---- --- --- ------ f S ti Tank: Distance from nearest well q 4-illel ap.cily----- - ----- __tn Liquid deyh---------- ----Capacity No. of compartments------I ------Size-- ----------Distance to nearest ;of I----- ------ Di I Field: Distance from nearest Distance from foundaf 1line-------.-__.----- 0 7t WidtLof trench----------- -- ---- Number o' lines----_---_--- Length of each line-- --------------- ------ Type material------ --- ----------Total length 0 P Type I filter material---, pth of filter rhc Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line--------- ------- Seepage Pit: Number of pits. material-----------------------Size: Diameter-----------------------Depth------------------------- ----- El pits----------------------Lining Lining Distance from nearest well----------_-----Distance from foundation.-.------_--------.Lining material------------------------_--_._-----. ------ Cesspook Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--- ------------------------gals. 0 Distance from nearest well--------------------------------- --------------Distance from nearest building--------------------------------- -------- Privy: Distance to nearest lot line----------------------------------------------------- --------------------------------------------------------------------------------------- 0 Remodelingand/of repairing (describe):----------- -------------- ------------------------------------------------------------ --------------------------------------------------- -------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------_. ------------------------------------------------------------ ----I----------------------------------------------------------------------------- ------ -------- --- -- ----- --------------- ------ --- ---- -- -------I-hereby_.certify_.that- I have prepared- --.-this-application-- -- .and__that__ he__work_.will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. ------ -------------------------------------------- ---------------------------------------.-------(Owner ------------------------- ---------------------(Owner and/or Contractor) (Sigri -----------------(Title)----------------------- --------------------------------------- ------- - - _--- -- ----- ----------- --- ---------- --- -- - ------ ---- - ----- -------------- By:_showing- - _s:1-ze-_o.f-_lot, iocatio.n of system-_in-_relation-- . -to-wells,- buildings, etc., can be placed on reverse side). (Plot plan. FOR DEPARTMENT USE ONLY 1111 Jill DATE-- 3�----- APPLICATION ACCEPTED BY-----------------III---- ------ ------•----------- ----------- -------t77 -S-_. REVIEWEDBY-------------------------- ----------------------------------------------------------------------- -------------------------- DATE---•--------------- ----------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- ------------------------------------------------ Alterations and/or re command afions:---------------------------------- ------------ ------------------ ---------------- -------------------------- -------------------------------------------------------------------------------------------I-------I------------------------------------------- ------------------ ------------------------------------------------------ --------- -------------------------- ------------------------------------------------------------------------ ------------------------------------------------------ ---------------------------------------- ------- ---------------------------------- ----------------------------------------------------------1---------- --------------------------------------------------------- - -------- ------------------------------------------------------------- --------------------------/Il------------- --- -------------------------- -------------------------I------------- ------------------------------------ Of ----------- ------------------------------ FINAL INSPECTION BY:.---------- ------I--------------- ---------- Date-------------/_ SAN JOAQUIN LOCAL HEALTH DISTRICT in Scamore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100