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J APPLICATION FOR SANITATION PERMIT Permit No. --�-- I r p (Comlete in Duplicate) ` Date issued ------r�----•--- .r " ; Application is here y made to the San Joaquin Local Health District for a permit to const ct and install the work herein described. � This application is made incompliance with County Ordinance—No. 549 " "" --------------------------- C ----------- ---' -- ---------------------- - ►. JOB ADDRESS A D LOCATION _ - phone_---- '^'--------------------- ---- -------- --------- ---- - --------------------------- Owner's Name_ ------_-- -- j"- -'-- t- ------------- ------ -- -- ----------- ----------------=------ - Address------------ Jt --• ---- ----------- one------------------ - --- ----- ------- Contractor's Name____ ❑ Motel Oth r A artment House ❑Commercial Trai r Court ❑ 1 r 4 Ins#allatinn will serve: Residence ❑ p J I f Number of living units: _ umber of bedrooms Number of baths ___ ____ Lot size . --- -- Water Su I Public system [ Communit system ❑ Private ❑ Depth to Water Table _____-_ ft. PP Y� Y Y Sand Lo;/N Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Y Previous Application Made: Yes ❑ No [ New Construction: Yes o ❑ Fre pp TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewe is available within 200 feet./)� M Vii L_______--- ------------ -- - ------------- Distance istance fro noun action---- --{,!___-_-- Septic 'ank:,5 Distance from nearest well__ -_- -----------Ca aci No. of compartments_____-" _ Sze --. - --> --•-Ligula dap�h--------- --- _�_ --___.Distance to nearest lot lin "�i_----------"` Di4spos F•seld: Distance from neo st ural)_--- Distance from foundation-- - t Width of trench_--�,--� _ ten th of each line_____-___�� Number of lines___ ___----. - --- - g ---Total length--------- --- -�--- - Type of filter materia r {' epth of filter material-- to nearest wel!---------------------=Distance from foundation-------------------.Distance to nearest lot line_________________ Seepage Pit: Size: Diameter------------------------Depth--------------------------------- V ❑ Number of pits----------------------Lining material-----_------------- -- Distance from nearest well__'___-=n--=Distance from,foundat.ion-------------------Lining material_______"_____________________ als. Cesspool: = _Li Liquid Capacity----------------------------9 ILA ❑ Size: Diameter-------------------------------------Depth q ---"____ _________Distance from nearest building ------- ------- ---------------------------------=_ Privy: Distance from nearest well_____.-_________"" _ - - ri „J --------------------------------- ------ ❑ Distance to nearest lot line--------------------------------------------------------- 171 ____________---"----- Remodeling and/or repairing (%desccr b f=----------------------------------------------------------------------- --- _. ' ---------------------____________________ _____________•-___-_--______--__--..-__ _ hklen accordance with San Joaquin County I hereby certify that I have prepareduot this ns Ilication and he 5 an ordinancesSt laws, and rules an reg .lasqu� LocalHealthDistrle} f. , __"---(Owner and/or Contractor) (Signed) �* y -' 0_-ef (Title) BY:--------- -------------------------------- -- -- --- -- - - - ion of system in relation to wells, buildings, etc., can be placed an reverse side). (Plot plan, showing size of lot, Iota+ FOR DEPARTMENT USE ONLY 1 ti DATE__ ------------------------------------------------- APPLICATION ACCEPTED BY ------------- -------------- ---- DATE-_&R-, ----------•--- -----------------------------" REVIEWED BY-------------------------- -------------=----------------- - 1 BUILDING PERMIT ISSUED--------'---------------------------------------------- D ------------------------------- ----- Alt at nand/or tom endations:�_--------_------ -------------- 11 /Jyp•}�Jrr{� -�F - j �Q _______ __________ __________ __-___ -.___ -------------------------------------- __________________________________________________________"-_____.___.____________________-__.-_________ ___________________•_..____ --------------- __ ---------- ----------------- -----------------------------------______ 2.4--Z L --------------------------------- Date" -- -:7:e �------------------------ �frr 1"INAL INSPECTION BY------ - -- ---- ------�� -- -- .�- I SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 30D West Oak Street Tracy, California 134 South American Street Manteca, California � Stockton. California Lodi, California ES-9-2M 8-51 Revised W-2404 _