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Permit No. APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Date Issued .�'/74 -- A lication i�hereby made4to he San Joaquin Local Health District for a permit to construct and ins_t, -the�w.ork h ei� describes pP / r�This application"'is made in co pliance with County Ordinance No. 549. r� y77tic --" � - JOB ,pp �DDRESS A OCA I - ---- ------ ---- -- ------ --- --------------------------------------- Ph -----------------------�`------ --------------- ---------------•------------------------- �Owner+s Flame - Ph " r � _-- ' --------- -- ��-, - - ------------------------------------- Address----- -� - --�-��-/--------- - -----------�---� - Contr, ctor's Name r ---------------- Phone.---------------------------------- ontra will serve: R siden e� FApartment House ❑ Commercial ❑ Trailer Curt ❑ Motel ❑ Other ❑ (Number of living units: __-_ Number of bedrooms -e _ Number of baths _/___ Lot size ----------------------------- t lft. Water Supply: Public system ❑Community system ❑ Private Depth to Water Table ____ Characfer of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loa E] Clay E] Adobe Hardpan ❑ Previous Application Made:; Y s ❑ No ` New Construction: Ye'q,-e-fNo ❑ PHA/VA: Yes ❑ No- TYPE OF INSTALLATION AND SPECIFICATIONS: �(No septic tank or cesspool permitted if public sewer is available within 200 feet.) f ' ptir- T k: Distace afro � nearest we l-----------------Distance from foundation------------•I-----.Material------------------------------------------------- No. of compartments--------- SiZe-----------------------•-------Liquid depth---------------- ---------Capacity----------------------- ispos` eld'.'." rst well _ _______________Distance from foundation___ ______- ______Distance to nearest lot line______-_._____.-. G Nuer tf Aes----- ---------------------\----Length of each line------------------ -:------Width of trench mb j ``� -,,lype of filter mate'rial--------------------\-Depth of filter material_______________( __ Total length________--___________----------------•-- ,.. ! ► l Seep. Pit: Distance to nearest, well___ __________Distance from -undation __-____ _.: Distance fo nearest lot line__ __ f r __ p, e t.:--- -Linin material S Number of its. =y-� 9 - S' De th Cesspool; Distance from nearest well_________________Distance from foundation___-__.-______.____.L.ining material___-____-_____-___---_-__----_______- amefer--------------------------------------Depth_--1---------- --------------------Liquid Capacity----------------------------gals. st well----- �-------------Dis nce from nearest building-- --------------------------------- --- El ize' i Distance from Weare ❑ Distance to' lot line--- -------------�------- -------------------- y ---- pairing {describe:_ ---- -- - - r F Remode n -------------------- -------- �_ \____________________c__}____ ,___...________.________________________________________ --- ------------------- --- ------- I herebycertify'that I have prepared this application and that the work wdl�.be done inteccordance with San Joaquin County ordinances, StZjjg�Wlwnd rules and regulations of the San Joaquin Local I-)ealth Distric .`� (Owner a /orContractor) (Signed) - �--------- --- � -- --------- -- C� --------------- -------------------- ` (Title) (Plot pla!, showing size off , location of system in relation to wells, buildings, etc., can be. p ed on rev se si ). 1 i — err FOR DEPARTMENT,USE ONLY APPLICATION ACCEPTED,BY____ _ ___ _ _ __ ___ so —1------------ DATE--/ --7-_,�.� - --------- >. REVIEWED BY---------- ------ y DATE BUILDINGPERMIT ISSUED------------------------------------------------------------x------- ------------------------------ DATE---------------------------------- ----- - --------•---- Alterations and/or recomm lendations --------`----------------------------------------------------------------•---------•------•-----•-•--- ------------------- ----- --------------•--------------- -----•--------------------------------------------------- ------ -------------- ------------------------------------ ----------------------------- r __________________------------------------------------_--------------------------------- ------------------- ___:, 3`, -. _._-___ .________..._ l ______ ________________ ___ ___._ _ ____..___-____- _______ _-__-__ __- _______ ._____- .__. ___._._.- _______-____________._- &,/d = hNAL ENSPI CTION BY: ---- ------------- Date ; �? SAN JOAQUIN LOCAL HEALTH DISTRICT 4h 130 South American Street,' 300 West Oak Street 132"Sycamore Street - 814 Horth C Street W Manteca, California Tracy, CaliFornie Stoekto�{�,.Yforni. Lodi, California ~ ES-9-2M Revisoa Q'-57 F P CO