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APPLICATION "F ,PERMIT Permit No. .--A------------------- ------------ PR S'ANITATION - _A_� - q ((�amplete�in Duplicate) Date Issued Applica4-ion is hereby made to The San Joaquin Local Health District for a permit to construct and install,fhe work herein described. This app is made in compliance with County Ordinance No. 549. ,licafion I t"tl - A/ 4 __1----------- ------ ------------- 0 of e----4�&_ JOB ADDRESS CIAJI K ----------- a'me - ------- ------ ---------------- --------------------------- --------------------------------------------- Phone------------------------- Owner's N --------------------- ------------------------------------ Address_11_J2j!oZ__---P--- 4. ...... .21- ------Phone----------I------------- Contractor's Name......... ------ Installation -- --- ------------- -—---I Installation will serve: Residence UT Apartment House El Commercial F1 Trailer Court [I Motel 0 Other 0 Number of living units: /--- Number of-bedrooms __a9- Number of baths ---L Lot'�size ----------------------- Water Supply: Public system El Communify'systern El Private [B�"Depfh to Watei�'Table' 7��7 Character of soil to a depth of 3 feet. Sand 0 Gravel F1 Sandy Loam ❑ Clay Loam E] Clay E] Adobe E] Hardpan B Previous Application Made. Yes F1 No New Construction: Yes Fj TYPE OF INSTALLATION AND SPECIFICATIONS: I - tank-or cesspool permitted if public sewer is available within 200 feet.) (No septi ,� -- ------- ic tan ..rorn 6" Maierial-7-------------------------- --------- f foun ofion---Z------------- Distance from riear;sf well---7 --- .4, 04 Septic T k- Size_iq:�� , -,z------ ----Capacity- ;7'*--Liquid depth _A/. ei No. of cornpa�rtments-------------------------- __)(_Vo�.�Y Disposal ielcl: Distance from nearest well---7 --------Distance from fo.undation---ZO- ------Distance to nearest lot line-Zo.. -Length of each line_-----.__-� As:.--•----. W'C'tk of trench_j#;�Y-------------•----------- e ------- -- ------------------ Number of lin'' /---- 7_111 I r filter material- -12--- -- ----Total length--------- ----------------------------- Type 01 filter maferial:�' &r ,.k -- ------Depth of fi 301. -arest lot line---/d--------- founclation---------------------Distance to ric Distance to nearest w.11 ,16-0 .......'D i s t a—n-c'e' IT- I Seepage�Pi�' material_ ..........Depth------ ------------- Number of pits----- ----Liriin�, m 0_j_cA_a__M--Size: Diameter_ Disf-a`n�ce from foundation_:-.---- --------- Lining material------------------------ -------------- near�st wells--_-"_____---- - I Cesspool: Distance from ------------ ------- ----------Liquid CapacitY-------------------- F1 ----------- -- ---------------Dep*___ Size:.Diameter crest lot Ii7eI--------------w--- -----I---'D_=istanc-e from nearest est building---------------------------- Privy: Distance from,ne 'est vZo------ 4 - -------------------------------------------------- ---- --- -------------------------------Distance ---t--o---n--e----- ---— I- ----------- Remodeling and/or repairing (describe):___._._- -- -f � , -------------------------------------------------------------------------------------------------------------------- - . ---------------------------ij------------------ I---------------- ----------- - I iI------------------------------I-------------- ----------- --------------------------------------------- ----------------------------------------------------------------------I------------ — -�_.j , - : ------------------------------------------------------------------------- r.4 J_ ------------------------- -----------------------------I-------------------------------- ---------I__----- ---hereby- - __------- ---certify-fy- -----that-a+__I__-------- have__p-repare'd this application and that the work will-be done in accordance with San Joaquin County ndlregulafions of the San Joaquin Local Health District. ordinances, State laws, and rules a �� r ....... . ----jqwner and/or Contractor) (Signed)_ _0,_a7r ------- At ------ ---------- By:------------- L -------------------- ation oi:,- ern in relation to wells, louilding-s. etc., 'can 6e placed'on reverse eide). (Plot plan, showing size of lot; loci Ft, — - � -- _-A - OR DEPARTMENT USE ONLY z 4 APPLICATION--A---C---C----E----P----T----E---D----------B----Y------------------------------------------------------- I------------------------------------------------------------------------ DDAATTEE --------- ------I----------I REVIEWED By BUILDING PERMIT ISSUED------------------------------------------------------- -- ------------------ -------------------------- ----------- - DATE - ------------------- Alterations and/or recommendations_________________---____-___.---_._ --------------- ------------- --------------- -------------------r------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------------- -1------------------------------------------------------- ----------------------------- ---------I------------ ----------------------------------------------------------------------------------------------------------- ------------------ ---------------------------------------------- -----------------------------------------------------------11-----------------------------------------------------------------------------------I ------- ----------------------- ---- -------- ------------- -1------ -------------- ---------------------------------------------------7 - ------------- ------ ------------------------------------------------- Date--__-_. -------------------- --------------- FINAL INSPECTION BY-------- ---------------------------------------:,--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 614 North "C" Street no South American Street Manteca, California Tracy. California Stockton, California Lodi, California I %if n Inn