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Permit l4e. _ ---- -- �` r APPLICATION FOR SANITA_T.ION PERMIT Duplicate) Date Issued __.f--- z (complete in ib Application is hereby---m to the San Joaquin Local I-#�a4th District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No 549. 7 'f --------- - (I�i -- ------------ ------ --------- _- - = 7. 4 � JOB ADDRESS AND LOCATION -- , -------------- -----------�-- P one--- Owner's Name-------- ' _` -- .__�-� -. � ------ ------------•------------------ ss. �" - ------------- ;," Phone- Addre Other ❑ --- •-r-------------------------------------------- ----- ---- -•------- - - Motel ❑ Contractor's Name---------------•-•-- •------ -- -" Trailer Court ❑ Apartment House ❑ Commercial ❑ Installation will serve: Resident I p __/__ Lot size ---- umber of living units:;_I----- umber of bedrooms_ Number of baths}h to Water Table�ft• i N Private ❑ Depth I Public system Community system ❑ ❑ clay Adobe Hardpan ❑ Water Supply: Gravel ❑ Sandy Loam ❑ Clay Loam Y ❑ Character of soil to a depth of 3 feet: Sand ❑New Construction: Yes ❑ No- Previous Application Made: Yes ElNo k TYPE OF INSTALLATION AND SPECIFICATIONS:c ewer is available within 200 feet.) (No septic tank or cesspool permitted if p , Distance from nearest well -_ Distance from foundation--------------------Material--------------------------------------------------- Septic _-- ----Capacity_--._-_--___------.---- S�ptic Tank: �. --- --------- --Size--------------------------------Liquid depth_---------------------- ��/ No. of ,compartments---------- �-^ ___-._.Distance from foundation-------------------W nth ofttrencheS� lot line----.------------ Dispos I Field: Distance from nearest wall-_-_____- z _ Length of each line-___-_- Number of lines------------------ -- ---------- Total length �- T e of fitter material-------------- Depth of fjlter material__--_---- j }once to nearest lot line* � } Yp foundation, - - -Distan Depth �� Seep a e Pit: Distance t e rest ll pia eta -- Number of ins a material------- --- ------ found tia=3r�'-�--- Liquid Capacity - gals. p�, Cesspool: Distan am nearest well------------- ---Distant -_: - Depth------------- r-�,--- ----- _ Size: Diameter --------------------- x . .. 4 — Fit. - ,k '.r ' Distance from nearest building-_ " ------- Privy-. - - ❑ rx -- t. 5----- --- . �• - Distance from nearest well___-- -,-- --� ___________ ------------ Privy: ---------•--------------- ❑ Distance to nearest lot ine--------- ---- --------- �--- "-- �� --------- � ------•---- – u r or repairing de tribe):-_-- - -- .^ Remodeling and/�p g � -------------•----- ---•----•--------•----------/ ------•------•---------•-----• - - - - --- ---- ------------- ---- ----------------------------- ----------- . - L - -- - -------------- •---- -- licat" and that the work will b! .done in ccordance with San Joaquin County re orad +his a p / I hereby certify th } j have p i A ordinances. State laws nd rules n regulatio of a San Joaquin . cal Health Dis+roc • ----(Owner and/or Contractor) -- (Signed)- gY;__-- r buildings, etc., can be placed on reverses, (Plot pian, owing �e of lot, low � n o sy�t m in relation to wells, FOR DEPARTMENTXSE ONLY - .. ------------ DATE----------- - --�- - ----- ----- -------------------------------------- � --- APPLICATION ACCEPTED By-------------------------- - -- --------- ---------------------- ----------- DATE------ -----------------•--•----•-----�---------------- t -------- ------- --------------- ----- -- -------------------- ------------------------ --- - DATE � REVIEWED BY-------------------------------•--------- ---� ------------------------------------------------------------------ ---------------- ------------------ - BUILDING PERMIT ISSUED------ -------------------------- ------------------ _ __ ---- - -------- -------------------- -- /or recommendations:- -- = � #''-�'".__. Alterations _ - - -- -- - ---------- - - ---_ - 4 ----- ------- _ -------- ---------------------------- - ------ --------------- D n /j -Q-' . --�� i ,.� Date- ---- --�i��! -- FINAL INSPECTION BY:----------q---- t. SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 132 Sycamore Street Tracy, California 300 West oak Street Manteca, California 130 South American Street Lodi, California t Stockton,.California I - ES-4-2M 8-51 Revised W-2100