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X1'1 Permit No. ._�� -•-2••Z APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued --- ct and install the work herein described. f�/c—JJ p�pplica}ion is hereby made to the San Joaquin Local Health District for a permit to construct � 7-0 1,�o2�iDA This application is made in compliance with County Ordinance No. 549. �as7- 7 Wi n^_ ✓� aA Ipp s-� ------ - JOB ADDRESS AN•LOCATION_:.----- - ------- ^ ?c!_ " Phone------------------------------------- Name---- ... ame--- `._..__. ._ .. ------------ . p".----------------------------- -- � ?�- ic j .. Address_..----•- G2 Phon `�f� ex- - ---- Contractor's Name--------------- --- --- -- - . Motel ❑ Other ❑ Installation will serve: Residence Apartment Ffause ❑ Commercial ❑ Trail Court ❑ , ^�i�� ` __ Number-of baths A%-Lot size _�--'-- -- -- �£ Number of living units: __ - Number of --- Depth to Water Table 3 d ft. Water Supply: Public system ❑ Community system Private ❑ P ClayLoam ❑ Clay El Adobe ' Hardpan ❑ Character of soil to a depth of 3 feet: Sand 11 Gravel [I Sandy Loam 171 Application Made: Yes ❑` No �� New Construction:-Yes ❑ Nox ► Previous App'LI + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within 200 feet. I---- � Distance from neares}'we}y.-�"_=�A'"""Distance from foundation__.-____...___-_.-,Materia----------------------------- -- Se tic ank: Size --- ------Liquid depth-------------- -----------Capacity--------------------�- r No. of compartments_____________ ��---.._•Distance to nearest lot line---��------ f distance from foundation___ Disposal HE- Distance from nearest wel - ' ,--Lenth of each line---.------>��-�---------Width of #ranch._-��------------------•-- ❑yI Number of lines_.---------{-- - n g.. ..�. _ - �_ s/ } ��f Depth of filter material.._." ..----- -Total length____-- ------- Q' - F_ Type oT filter material_-_ P S ep ge Pit: Distance to nearest well----------------------Dis an e from foundation Diameter__- Distance to Dearest lotpt h "line----------------- Distance _-----. -- f �' It n ' Number of pits------------- -Lining m \ Distance fram nearest well-----------------Distance from foundation._.._- Lining material------------------- T Depth Liquid Capacity gals. p Size: Diameter------------------ -- ,P. ----------- N ❑ V.-I_ __--._ . ._Distance from nearest building Privy: Distance from nearest well----__._ . . ----------------- - - ------------ ----------------------------------------. --------= - --14----------------- ❑ Distance to nearest lot line.-.____"_. �- � lw - -------- iY94 Remodeling and/or repairing (describe):--- .- - __--__--"____._________-____-- _-,� ------- - -- ��.: � ------...- ------------------------ -------------- ---------------------------- if that I have prepared this application and that the work will be done in accordance with San Joaquin County I hereby certify ordinances, State laws,and rules and regulations of the San Joaquin Local Health District. - ---_-------------------{Owner and/or Contractor( ------------- - ----- - S Sined -- ------------------- ------- 9 1 / J (Title]- :� ------------- (Plot plan, showing size of lot, location of system in r6lation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f DATE.------ ------ Y_ ---- --- 1 APPLICATION ACCEPTED BY DATE_ M� - ----------------------------- - +�, REVIEWED BY---------------------------------- DATE--- , ��rr ------ ------------- BUILDING PERMIT ISSUED tions:__ -- {l -- :. ----------------------- ------ Alterations and/or recommendations---------------- - •...... i -- ' -------.---- r �. .� .r.. --------- ------------------- . -- Date.----------,-- FINAL INSPECTION BY:---------- - - ---,e-- 4AN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 132 Sycamore Street ! 130 South American Street 300 West Oak Street Manteca, California Tracy, California Lodi, California Stockton, California ES—9 145446 ATWOdO "