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2, Permit No. _ APPLICATION FOR SANITATION PERMIT --. -q (Complete in Duplicate) Date Issued --/"--- '2 —�/S'0 0 A lira#ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work Cerein described. pp �7 This application,is.made,in compliance with Count Ordinance No. 549. lL�, AW JOB ADDRESS AND LOCATION--------- D_ ----- / �' ' - -,r ------------------ one---/ __K/ ---- Owner's ame----------------------- -- - ' ---------------------- Address-------------- Qh?wt�Ca 2, --------- ------------ Phone----------------------------------- ----- Name_____________ - -------- ❑ ❑ �Use ------ ---------- Installation will serve: Residence [ Apartment ❑ mmercial ❑ Trailer C urt Motel Other ❑ Number of living units: ---- Number of bedrooms _-_oZ- Number of baths ____L Lot size Water Supply: Public system ❑ Community system '❑ Private Depth to Water Table __6o ft. Character of soil to a depth of 3 feet: Sand ❑ Gra el S ndy Loak Clay Loam ❑ Clay ❑ Adobe❑ HardIUIVLpan ❑ Previous'Application Made: Yes ❑: No [ New Construction: Yes � No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V ; Septi Tank: Distance from nearest weld_00_:7 _Distan e�from foundation___->f D-----------Material------ t ------------ h No. of compartments-----------a___-____Size__�Ll --------- -5_X__CJ--- quid depth________-----------Capacity__fa4�.-----__ Disposal Field: Distance from nearest well_j0a±__.Distance from foundation____ _ ________Distance to nearest lo ____ _--______- chW Number of lines---------- L � - ! ---------------a`______. _ Type of filter material_5T__> --Depth of filter material---___/_�_____ _____Total length_______ _ ________________�_ See age Pit: Distance to nearest well:___-O Q istanc 1,�T oundation_-_ _t�r__.___.Dist nc nearest lot line_- - -- .r _'— Depth------ -- Number of pits------- ------------ material _ _ Siz : Diameter_ ____- ,_ g T . . esspaol: Distance from nearest well____!-0__--__Distance from foundation____-1_z--___-. material___�ST Depth "r--- ----------------------------------Liquid Capacity------- O --------gals. Size: Diameter-----3-------•----------- p / Distance from nearest well----_____ ---------------------------Distance from nearest buildin f Trap Dist c�re lot line__ 30------- - = ! g �- Remodelin and/ rep iring (descri e}-------------- ----------- - ---------` - V ------- ---- - -------- 1 / " - ------------------------------- 411 �3 ..___�____-- - --=---------=----------------------------------------------------------------- --- I hereby certify that I have prepared this applica ion and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulatio of a San Joaquin Local Health Dist . (Signed)------------ -------------------- ` TI#le ---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE------------------- !. j APPLICATION ACCEPTED BY----------------------------------- -- ---------------- ---------------- -REVIEWED. BY--------- -------------- DATE--------- --- -------------------------------- ter----- _- ----«.T:- -_y' ----.-`- .5 A / _ BUILDING PERMIT ISSUED_ -------------- DA ' = = =_ --------------------------------------------------------------------- ------------------------------------------------------------ Alterations and/or recommendations:_________________________ ___ . --------�-o--- ---------------------------------`----------------------------------- -------------------- ----------- ---------•----------------------- - ° r- -� Z f' /-"-- "' .�Ct. 1_4 /f..{r _- _-- —' ---`--=x ``' a fir/ f7 � p ----- ��`'-----`" -• w,r `". ?-'-------U ---._- -- =fl ' _-f '�.t :± ,--1--- - ------=---' ---------------------------------------- - ' FINAL INSPECTION BY: ------------- Date--/" " !`nfir` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100