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Permit No. ."_(2 APPLICATION FOR SANITATION'N PERMIT (Complete in Duplicate) Date Issued Local Health Dct for a permit to construct and i stall the work herein described. �JA, permit construct dan13 I S' Applica+ion is hereby -made to the San Joaquin Loc Ordinance No. 149, This application is made in compliance with County JOB ADDRESS AND L CATI N-------1:446...... ---- -- Phone------------------------------------ ------ --- --0-R ---N-1------------------------- - --------------------------------------- 1 - 5 --ZA Owner's Name------------- -------- e--------- %5�20<e ----------------------------- 7 . ......... 17OA/------------------ Address----------------------- --------- Phone . ......... Contractor's Name____ -A . Other Installation will serve- Residence .O Apartment House El Commercial ❑ Trailer Court [I Motel El —-----El------------------ Number of living units: -1---- Number of bedrooms J�' Number of baths -1---- Lo r f size ----�00X 1.0-0----� De --- Water Supply: Public system 0 Community system E] Privafe,Cjpth to Water Table -------- ft. Clay Loam [j Clay E] Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand [] Gravel El Sandy.Loam 0 Previous Application Made: Yes El No %, New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: available within 200 feet.) (No septic tank or cesspool permitted if public sewer is Mater'%al-. ------------- nearest well-t1j0z4r----Distance Distance from foundation-__:___d._.__._- -------------- Septic Tank: Distance from 57;?....... ---------Capacity- II- -------Liquid clep*L No. of compar I tments--,- ------- ...... size, t'on-.30-11--------- Distance to nearest lot liine--�!�.......... Disposal Field: Distance from nearest we1LX9jN5'--Distance from founda i Width of frencb.--,--'-0--------------- -------- Number of lines--0-HA--- --------------Length of ea6.line---;W- ------------- gth-------Z 40- 'All,R.tGKt--Depth of filter material-1 1-'_.------.Total len ------------------------- K Type of filter material foundation--,6 : --•--Distance to nearest lot lige__ --------- Seepage Pit: Distance to nearest well.N491-(+r--------Distance from ------- &�ta,K -"-ize: Diameferm,16-fi-------- Depfln--Zo---------------------- tN Number of pits 6NC---------Uning material- . .... , dation. Lining material____..__.___-___..____ ------- Distance from'nearest well-----------------Distance from foun .. ...... Cesspool: L-iquid Capacity-----------7--�-------- Size; Diameter------ ----------------------------- ---------------------- 0 ............... ...... ------------------------------- -------- -.-Distance from nearest building-- Privy: Disfance Irc ;nn'frearZst—wgll ----------------------- ------------------ — El Distance to nearest lot line-------------------------------------------------------------------------------------------------- I --- ----------------- -------------------------------------------------------- Remodeling and/or repairing (describe):_._,- - ----------- -- -- ------------------------ ----------------------------------------------- -`�- ---------- f--------- ... ....I--------------------- ----------------------------- ------------------------------------------ ------ -- --------------- ----------------------- ------------------I------------- ---------------------------------------------- ------- ------------------I------------------------------------------------ --- ------------- --------- ---------------------------------I---------------------------------------------- -------- -------------- ----------------------------------------------------------------------------------------------- will be done in accordance with San Joaquin County I hereby-certif I have prepared this application and"that the work p St rules g n;re San �'o�a-4quin Local, Health District. ordinances, State aws, d rules and gulatio 1� For contractor) . ........ . L (Owner, an# -—- --- ---- ------- --- ---------- (Signed)-------- -- - ----- -- - -- ------ J------------------------ ------- ---—------ L -- ---- - -------- .. --------P ----------------- --------- ---- By:-------------- 'o to we S, i be plat on reverse side). buildings, etc., can(plot plan. showing size of lot, location of system in rel ion to wells, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ - --------- ------------ -------- ------ -----------------------------7----------------- DATE--------------- ----- - ---------------- IDATE---- ------------------------------------------------------- REVIEWEDBY------------------------------ --------------------------------------- --------- DATE------------------------------------------------------------ -------•PERMIT ISSUED-------------------------------- ---------------- -----------------------------------------I--------------------------------------------------------------------- Alterations and/or recommendations:--------------------- -------- -------- - --------------------------------I .,"__.-""-.___._________--_-. .V ----------- ------------------------------------------------------------------------------- ---------------------------- ----------------------------------- -------------------------------------------------------- -- ------------------- --------------------------------------------- --------- ---------------- -------------------------------------------I------ ---------------------- ----------- --------------------------------------------- ---------------------------------------- -------- -----:----------------- ------- -------- -------------------- --------------------- ------------------ ------ -------- -------------- ------ ---- --------------------- ----------------------------- ------------------------------------------- -------------------------------------------- Date------- ----- -------------------------------------------- FINAL INSPECTION BY:_.__-- ---086--------------------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 130 South American Street 30D West Oak Street 132 sycamore Street Tracy, California Manteca. California Stockton, California Lodi, California EF;-9-2M 145446.47WDUD 12.54