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1 /! APPLICATION FOR SANITATION PERMIT Permit No, --_--- (Complete in Duplicate) P ) -`� Date Issued l/�. "a'[ _`` / Application is hereby made to the SanJoaquinLocal Health District for a permit'to construct and install the work herein described. This application is made in compliance with County Ordinance No-.549. OwBnerADNamse AND iLOCATION,------ 3 -'-_- - ;-_CX1l ! lL-`Z1 ------- -- 14�- ------ — �- --`------------ Phone Address---------- -------------- - , - ------ �� ------- N _ - [ p � ❑ ❑��-------�p�........ Phone- Installation will serve: Resid ----------------------------------- Contractor's ame_______-6�' A artment House Commercial Trailer:Court ❑ Motel ❑ Other Number of living units: _.L:- Number of bedrooms ----- Number of baths __/-_ Loft size---__ Water`Supply: Public system' Community system'❑ Private El"'Depth to Water 7a61e'�'�"-ft. Character of soil to a depth of 3 feet: Sand' Gravel Sande Loam Cla Loam ! ❑ Y ❑ y ❑.Clay ❑ Adobe Hardpan F] Previous Application,Made: Yes ❑ allo- # New Construct ion:-Yes-�o ❑: . F,HA`VA: Ye's ❑ No TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public.s ewer is available within 200 feet.) _n Se k:k: Distance from nearest well_ V---.----Distance from foundation_- 1 .Material_.__ : ry k ---- ---------- -. LJ No. of'compartmenfs------_-- - --- Size_ -X-- -_ -- -Liquid depth----.------- --�_Ca acit .----�+ { Disposa)"Field: n Distance from,nearest well--,-. _.!Distance!Distance from founoation___�1�_,_-------Distance to nearest lot lin - _----- [[ - n Number of lines-----`------ '- -- -_!Length of each line----------. -C?--r ----Width of trench.-__-:-- - ....... • ---- y Type of fifher material_-. 0 _De" Depth of filter material____.___[ Total length--__-__--- ----- - --_-- Y Dis#ante ,to nearest well_------------------- Distance'from foundation_______ __:Distance to ndarest lot line-_--_---------- F-1 See a e Pit: Number of its.: . p ----- '- Lining material-.---- --F ._Size: Diameter,----------------- ----Depth_ ... ---- k i # Cesspool: Distance from nearest-well ----------------Distance frorh'foundation---------------.___-.Lining material----_______._____--_-__---- 5�ze: Diameter -- = Depth ;,== --_ _. ___-----.Li Liquid Capacity 1 ,. t � - q - ---------- -------------gals. Privy: Distance from nearest well..`. ---------------------'_-- _-, Distance from Enearest buildingr ! ❑ +' to nearest lot line.-.. :L-_- t. --i I - —_ i , ----------------------------------------- -,--Distance -.,d.,.r-_-I- W _.j � ""_ --- - » Remodeling and/or repairing ___-_ --_ - - �-- - ` = - I _ 1 .. ---------------- -- -------------------- -----------------------r _ I hereby certify-th t I hare-prepared'this application and:that the work will be done in accordance with San Joaquin Count ordinance$, State law a rules and regulatiorit.t f-he San Joaquin Local Health District. ` .� (Si ned - -- '' r w ran r 9 -""--''- .. �;--------- (Owner t t --- o c Plot plan, showing size of lot Iota f of system in relation to wells,'By:- { P g _ ------ _f ---------------(Title)--------------------------------------------------------------- �. s Y Is;buildings, etc., can-be placed on reverse side). t FOR DEPARTMENT,USE ONLY I APPLICATION ACCEPTED BY-------------- -- --___-.- _- _-- - y -.---------------------------------------- ---- DATE ---- REVIEWED BY-------------- ------ - ._ : .. --------- BUILDING DATE ---- ----- PERMIT ISSUED----; , --------- ------=--------------------`------ --------------- ------..-.-- -- DATE---- Altera ions and/ e mmenetions: --------------- 2'ha1r _ -' -�-----° -------------------- --------------- ----------------- ------------_------------ ------------------- }. . . -------------------------- ----------------'`------- -------------------------------- ----=- , , w FINAL INSPECTION-INSPECTION BY:---, ----- -- ----- SANLOCAL-HEALTH - - JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Stree} !32 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California �'E5-4�2w1 Reviseo 1-57 F.P,CO.