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6 v� �— APPLICATION FOR SANITATION PERMIT Permit No. 4.`1 '1/_f•-•_ C _(Complete in Duplicate) �- Date Issued �11„t_ Applica4ion is hereby made to the San Joaquin Local Health District for a'permit to consfruc alnd install Q herein/descri d. This application is made in compliance with County Ordinance No.:549. JOB ADDRESS AND LOCATION.____ c�_ r -� , y� --------- -- ----- Owner's Name-- - tiG /r. y --------------------- -- ----------------- Phon -- �, �s Name_.---�_.. _�(€�-'t .-•------------------ -•-- . .----------------------- P one ---•----------- ------ Installation will serve: s' ence ❑ Apartment House ❑ Commercial ❑_ Trailer Court ❑ Motel ❑ Other � ,fie�! f ;�. -..Number6ofJ v.ing units: ,,,_-,.Number of bedrooms -------- Number of baths r _- Lilt size" Water Supply: Public system ❑ Community system'❑ Private]B,,.Depth to Water Table Character of sail fo a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 15s Clay Loam E] Clay E] Adobe❑ Hardpan ❑. -Previous Application Made: Yes ❑ NOX � New Construction: Yes . No ❑' TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if pu6lic sewer is available within 200 feet:) Septic Tank: Dista nce.from nearest�well____ __________ -Distance ffom fo nd f* -_-=--f--------.Material--:----------------------�L{ -- �_ No. of'com artments_____-- - _ � �-��_Liquid de th-_____ i • P -- - :;--Size------• ----- � � 'P. =------Ca aci Disposal .Field: Distance from nearest well- �"-Distance from foundation___�Q -� Distance to nearest lot line¢.-- Number-of lines--------- Length of each line __- r 9 �_ Width of trench.-- ' T' e of filter material--- __- . YP lad Depth of filter material_-- _ _ -------Total length-------------�Q------------------ Seepage❑ ' it Distance #o'nearest well-------___________---Distance from foundation------------------ Pit _.Distance`to nearest lot line_________________ Number of pits-- --------------- Lining material---------------' -------Size: Diameter----------'_-'-----'- - - Depth ------- ------------------ - -- Cesspool: i Distance from nearest-well_________ ____ _Distance from foundation_-. nindg material ' ❑ ; •. Size: Diameter------- ,--Depth ' =` - - "' Liquid-Capacity gals: Li PrivY:; Distance from nearest well.._ _____._._ __--________Distance from nearest buildi'n +. 9--------•---------------••----- ----. „rte Distance to nearest lot line________-----_--__-----. _- V ---------- ---------- --------------- --------------------------------------- ------------- Rerno'deling -------- Remodeling and/or repairing (describe):---------------- • �F --- •------------- ----------- -----------=----•------•---•-•--•-------•---------------------•----------------------------------•--- ----------------- 11 • -' '------------------ =-------- -- -- -------•- .L-. ___________________________ __-.._--_ 1______ __ _________ _ _____________--------------------------------------------------------------- --- -_-____ ________________-________-____--- ___ .` I hereby ce�rfify fhaf l-have prepared fhis application and that the work will be done in accordance with San Joaquin County . tordmancesr Sfate laws, and rules and regulations of the-San Joaquin Local Health District. ) - ---- ---- . 1 ------ -------------- (Owner and/or Contractor) --- ------- -- - - ----------{ ifle)------ ----- ------- { plan,'showing�izWeflot, location of system in relation to wells, buildings, etc., can'be laced on reverse sid'e). Plot. FOR DEPARTMENT USE ONLY I�1 � ir APPLICA I IOrV ACCEPTED BY__ 'E .- REVIEWED BY---'---=- ---- -- --------- - DAT ; - DATE1-�BUILDING PERMIT ISSUED - .r, . . = ti--. mDAS-------------- Alterafohrecommendations: '---------------------------------------------------- _______________________________________ ------- - i ___________________________________________________ 8 -----------------__________________________________ _________________;________--_____-_____--_______ ._._.._.._--_-____________________ ,fFfNAL- INSPECTION XvBY:--- x ------------ Date----------- /7� ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South,American Street 300 West Oak Street i32 Sycamore Street 814 North "C” S+rae+ t Stockton; California Lodi, California Manteca, California ` -• . . Tracy, California- E5-9-2M Revised W-2100