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SANITATION PERMIT permit N( - ---------- ------------ APPLICATION FOR S a (Ccirriplete in Duplicate) Date Issue ---------- ---------- Applica+jon is hereby made to The San Joaquin Local Health District for -- permit to construct and install the work herein described. This application 'is made in compliance iwith county Ordinance No. 549. LAZ Z /.57 --epn-------------------------------------- JOB ADDRESS AND LgCATION-..-.)-&--------------- ------- -0" -A16-AtJ--V-f-- C ------ Phone Owner's Name. -------------------- - - Address Address- A Phon---- --o-----k----y---o- 'R------------- --------------------------- Contractor's Name---------------- rnercial 0 Trailer Court [I Motel El Other 0 Installation will serve: Residence [B/Apartment House 0 COM Lot size ._. ----- Number 1P.1P- - ------- -------------- __?,-"Number of baths Number of living units: _--/-_- Number of bedrooms Water Table 4- fern 0 Private F] Depth to Wat dobe 0-11`k' ardpan Water Supply: Public system a,-'Community sysCla tem.I Sandy Loam 0 if.. Sand 0 ❑ Gravel ❑El C,8 Character of soil to a depth of 3 fee 0 Clay No � Construction: Yes 0 No Previous Application Made- Yes F1, TYPE'OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) No septic tank or cesspool is avaa ool Permitted if public . Material----------------------------------------------- I ares� well_________________Distance Distance from foundation----------------- - Capacity-------:- ------------- S�.P�,, Tank; ----Distance from ne Size-------------------------------Li�quij depth----------------------- I compartments---------- --------------- N o. of -------Distance to nearest lot lme______.__._______ nce from foundation ----- --------------- arest well-----------------Dista Width of trench------------ , �3- Distance from n.e f each line........... ------------------ --------------- Num.ber of lines----------------- ---------I-------Length 0 --------- ---------Total length--------------------------- ----Depth of filter material--- .1 material-___-.--_------------ f zo- Type of filter L e flunclation--4.0--------Distance to nearest lot line---- 1 well - Z-5-�--------------- -n& Distanc Seepage Distance to nearesi we 1-0 ining material- Dlameter---7-11------ -------Depth ;�p i -- 0 --------------------- Number of pits:-- -- -------------- Lining material----------------- Distance from .'nearest well-----------------Distance from foundation- --Liquid Capacity------ ---------------------gals. Cesspool: Size: Diameter',-------- -------- -------------------Dep*----------------------D-I-5f-a.nce from nearest building--------------------- ---------------- Distance from k nearest well ------------- ---------------------------------- - ----------I--------------------------------------•----- ------------- Distance to ne�re5t lot lane_-------------------------------------------- --- - ing (d - - e s I cribe):---------------- ---------------------------------------------- ---------------------------------------- --------------------- ------------------ -------- ----------- Remodeling and/or repair --------------------- ------------------------------------------ - --------------------------------------------------- -------- ------------ --------------------- ----------------------------------- ---------------------------------I-------------------------------- ------------- ------------------ ------------------------------- - ------------------------------------ ---------------------------r------rest ------------------- d that the work will be done in accordance with San Joaquin County t ----------i------ -��t- ------ pr ared this application an, I her by c rfify that ,have' regulations the San Joaquin Local Health District. ordinance State laws, a les a reg;u' 0 awd;�ar Contractor) ..... .... ------- ---- -- - ----- ---------------------------- (Signed)----- - - -- -- -------- -- ------ --------------------------- ------------------ ------------------------- By:------------------------------------------------------------------ n elation wells, b 1 clings, etc., can be placed on reverse side). (plot plan, showing size of lot, location of sysfe i d FOR DEPARTMENT - E ONLY DATE-46-------------------------------------------------- -- ------------------------- - APPLICATION ACCEPTED B .. ...... -------- ----------------------------------------------------I----- DATE_-. V%-------------------------------------------------- REVIEWED BY----- ----------------------- ---- ------------- -- ---------- ------------ -11------------------ DATE---------1p------------------------------------------------ V -------------------------------- BUILDING PERMIT ISSUED---------------------------------------------------------- Alterations and/or recommend--tions---------------- ----- ------------ --------------------------------------------------------- ----------------------------------------------------------- ---------------------------------------------------- ------------------------------- ------ ----- --- -------- ---------------- -------------- -----I----------------------- --------------------------------------- --------- ------------ ----------------------------------- ----------- -------------------------I------ ........ --1_:------------------------ ------ --------------------- ---------------------------------------------------- ------- ------------------I- ------------------------------------------------------------- ------ ------------------------------ ------------------------------ ------ ------------- ------------------- --------- ----------------------I------- --------------------------------------- Date-... 4........ FINAL INSPECTION BY:-.__..--- ------ ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Sifse' 132 Sycamore Street Tracy, California 130?south Ai:�rq,-an Street 300 West Oak Street Manteca, California Lodi, California sto,kton7-Califomla