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APPLICATION FOR SANITATION PERMIT (Complete in Duplica+e) Perm.'No. Date Issued J --It --- �* ?/3-1/ -- --- &_ �/ 4-1 n k hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r%pp Cv - This application is made in compliance with County Ordinance No. 5411 .f- -,� = = _ JOB ADDRESS AND LOCATION_- -ZY Phone-- %71,A17 Owner's Name ............... '.7 -------- 7 ----------- ------------------------- ------- ----------------------------------------------------------- ......... Address ----- I., ------ 2e -"S__ Phone ----------------------------------- ------------------------------------------------------ Contractor's Narne ------------- oe- 49 rlb ---------- ------- -- 'k -..v- - Trailer Court E3 motel 0 Other [I Installation will serve: Residence Mo"Apaefrne;_t HoGse.[D—Commercijal --------------------- Number of living units: Number, of�beclroorns -.Number of baths:._�?_ Lot size -IA?f X - unity system El Private ArDepth ito Water Table Y_,!0,7 ft. Water Supply: Public system R -Comm SandLoam' 0 Clay Loam El Clay Adobe 6-5-ardpan [I Character of soil to a depth of 3 feet: Sand C] Gravel [I y Previous Application Made: Yes 0 No E� New Construction, . Yes E--10 0 TYPE OF INSTALLATION AND SPECIFICATIONS: feet [Noseptic tank or cesspool permitted if public sewer is available within 20 I�A a te r i a 4 ------ n ation ---- --- -- •----- ------ -- Distance from nearest Distance f om foundc, j Septic Tank: �4_2-�Capacity_ r= No. of compartments--------------- - --------- ---- Size_ --- Liquid 8,e 2.1 — line --- 1-6- ......... -....Distance to nearest lot Distance from nearest weL_ill._,b_4P -------- D�stance f rom founda+io'n -- -------- ---- Af Disposal Field: - -------- -- 11 -Len of each line_---! - ------- Width of trench... ----------------------- Nu'mber of lines....._.. ........ material----- -- ------ I ------------ filter material-/ ----------Total length Type oT j- Depth of filter L tion ---- V -------- Distance to nearest lot line__J� ----------- Seepage'Pit: rest well. ---- - ----- ----- Distance from foun4,a tis-..-- 4,17__ ------------ Distance to neai z e: D i a m e t e r/ LVITD e Number of pits----1---------------Lining 1W -------------- L"i,g materialAC-e W4 I Cesspool: Distance from nearest well -fmaterial ------ 1 --- ------------------------ Distance from foundation. -.--.-------------Lining - --------- Lining --- Liquid'CapacifY ... ------------- ----------gals. F-1 size. Diameter----------------- -------------------- D ; pfh ------------------------------------- ------------ f 4rom D;stance from nearest building ------------•---------------------------- Privy: Distance fnearest yell------------------ -------------------------------- 4 I r� ------------------ rest lot line ------------------ ------------ ------ ------ ------ ------- - --------- ❑ Distance to nearest ------- - 0� . ........... cr--------9 . ...... repairing (des, I ibe) 6? --- -------- 9 vl�_ Remodeling and/or oee t------------------ --------- ------------------------ ------------------------ Z ------------------------------------- ------------------- -------------------- ------------------ -------------- ----- ------------------------- -------------- ----------- ----------------------- -------------- ---------- ----------------------------- ---------------------------------------------------------- -------- ------------- I ---------------- -------------- i ------- I ------------------------------------------------ --------- I ------- - -------------------------------------- with San Joaquin County -------------- -that the work will be done in accordance wi I hereby certify that {have prepared this applicatio� and ordinances, State laws 4and rules and regulatio s of the PSan:Joaquin Local Health District.- Contractor] W" (Signed) -------_--------- /5,04;6_1 -- - --••---+-- --- (Title) ----- .......... ------------- /C� ------------- --------------- i9y: -------------- ---------------------- .- r be placed on reverse sWe). (plot plan, �showinq SiZG 'of lot, cation of system in relati on to w6lls, buildings, etc., can FOR DEPARTMENT USE ONLY DATE------------ -- ---------------------------- i - APPLICATION ACCEPTED BY------------ ----- -- ----- ------- ---------- -------------- -------------------------------- ------ DATE- J-.._.. ------------- -------------------- REVIEWED BY----------------------------------------------•--- DATE. -----\- BUILDING PERMIT ISSUED------------------------------ -------------------------------------------------------------- Alterations and/or recommendatio'ns: ------------ \ ------------ ----------- ------------------------ -------- ----------------------------- -------- — -------r, ------------------------------------- --.-.-.-.-.-.-.............-.. ----------------------------------------- --------------------------------------- -- ------------------------------- ----------------------------------------- ------------ ---------------------------------------I----------------------------------------------------------------------------------------------------------------- --------------------N---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------ ------------------ ----------------------------------- ---- --------------- - ------------- ------ FINAL INSPECTION BY------; --------- F - - - - - SAN JOAQUIN LOCAL HEALTH; DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 Wes+ Oak Street Manteca, California Tracy, California Stockton, California Lodi, California E51_9 145446 ATWOOD