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_5�Permit APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued .V----?1--------- Applica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install th6 work herein described. This application is made incompliance with County Ordinance No, 549. ----------- -------- JOB ADDRESS AND L CATION---- Phone---------- •------------- F Owner`s Name-----------: r ----------------- Address_.----------------- sa_�----------&AW- 7-16t,------------m..................... ne,1Q747flk77--- Pho Contractor's Name_______-.___ Apartment House 0 Commercial 0 trailer Court 0 Motel ❑[I Other ❑0 Installation will serve:- Residence [A � bedrooms --%"Number of baths Lot size 470--------------- -------------- Number of living units: Number of b Community system El Private [] Depth to Water Table -.TjO ft. Water Supply. Public system * Sandy Loam ❑0 Clay Loam [_1 Clay 0 Adobe obe K Hardpan 0 Character of soil to a depth of 3 feet: Sand [I Gravel 0 Previous Application Made:. Yes 0 No%. New Construction. Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool'permiffed if public sewer is available within 200 feet.) , Material------------------------------------------------- Septic Tank: d& Distance from nearest we'll--- ------------ f -Distance from foundation_________________ 0 pj 3 In No. of compartments------------- ---------------Size--------------------------------Liquid dep�h----------------------------Capacity----------------------- Distance from nearest well.-----------------D�stance r reach --------------------Distance to nearest lot line----------------- Disposal Field' 'Length of each line------------------------------Width of trench------------------ ----_. I----------- -------------------- NAb6r of'lines----------- material____.____________--------Total length---------------------- Type of filter material-------------------------Depth of filter 0 4 1 e from foundatiton__,�-A--_--_-.,Distance to nearest lot line- -------------- Seepage Pit: Distance to nearest well_,-�, _�____Distanc ---- ----Dept h,149-_`-------------- Number of pits-40?U2--------Lining -:Size: Diameter-e=3-1-- N 5d --Distance from foundation---------------- ---- Lining material_____.---_-_____.__._________-----_-- I Cesspool: Distance from nearest weQ-------------- ....Liquid Capacity--------I---------- -------9011.❑ Z, Size: Diameter--------------- ------ ----------Depth---------------------------------------------- ------------------------------------------ Inearest -l-,---�Dist'an;ce-from-fnearesf ---------—-----------------Distance from, - , building r�,��y nearest lot line_________________________________________- ------------------------------------------------------------------------------------------------ ElDistance to f a ------------ ---- --------A -- #------------------------- ----------- -,Remodeling and/or repairing tdoscribe):------_ --- -7, - LA44-4411 V- ------- �60 1jV 5 3, ------------------ ------------------------------------------------------- ----------- -------;�--------w------1------ -------- --------------------------- ------------------------------------------------------- --------------------------------------------------------------------- ---------------------------------------------------------- -----------d---------------------------------------- --------------r---------------------------------------------------------------------------------------- I herebycertifythat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la: s, an ules and regulations of the San Joaquin Local Health District. P r aud/or /1 4 Cal ------------ ------------(Owne C tractor) ---------- -Z '6 (Signed)------------------ P - -- --------------- 4 -----(r1tIe) -_ . -- -- -- --------------------- -- -------------------- --- ----------I------- BY-------------- (Plot y:------------- --------- t, location /el-i can be pla on reverse side). (Plot plan. showingsize OfIo :a ion of system in relation to FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ----- ------------------------ ----------- ---------------------------------------- DATE----- _!----------------------------------•--------------- 49* ATE------ REVIEWEDBY---------------------------------- ---- -----------------------------------------------------------------------•---------I--- DT ----- ---------------------------------------- BUILDINGPERMIT ISSUED--------_"---------------------------------- ---------------------------------------------------- DATE------ ------------------------------------------ Alterations and/or recommendations:-------------- ------------------------------------------------------------------------------------ ......... ----- ------- ------------------ -------------!------------------------------------------ ------------- -------------------------------------------------------------------------- .1 k. -- ---------�4 ----------- 1;na ----------- -------------------------- ------ ------ ----------------------I------------ 114e,:ze---------Vj --------------------------------------- --I------ ------------ •---------------- ----- ------------- -------------------------------------t---------------------- ------ ---------------------------------------- ---------- ------------------------ --- -------------I--------- Dai�------------ FINAL INSPECTION -BY::...... ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 132 Sycamore Street 13o South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca. California r-,_Q_?M Revised W-2100