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V X APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate} Date issued Alica+ion is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. Thppisapplication is made in co / mp iance with County Ordinance No. 549. -Iq r.47 4�h LOCATION______________JOB ADDRESS ANDPhone . A: Owner's ---al-I -------------�!------------- �_ Address---------------------- ---- ---------------------------- ----------------------- ph on Contractor's Name_______________________________ - -------------0 Commercial i al 0 Trailer Court E] m otel 0 Other Installation will. serve. Residence 0 Apartment House ❑ COMM 5 ... Lot size ----- ------ Number of living units: ----I---- Number of bedrooms ----- .- Number of bath ---- --- - _*,� ff. -I Community system 0 Private 2 Depth to Water Table Water Supply: Public system F lay Loam Clay ❑ Adobe and an C1 Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam n C Previous Application Made: Yes 0 No 2----N-ew Construction: Yes g---Ko 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool Permitted if public sewer is available within 200 feet.) Distance from foundation-4 ---- ----- - - --------- Distance from n -----Material ---- -----�'- __ __1 nearest well �apaci --- --- Septic _-Liquid depth_. -_--- --------- �62,± No. of compartments.-.2r_---------------- .01 AMC—. ,SV Orin ------------- OP Ir Disposal Field: Distance from nearest well- Dista foundation_ ---------. Distance to nearest lot line.- 01 lines_ /--------- Length of each -------------.Width of tren6,----;71 A/--------------------- Number «--moi-------- --- --- --------- Type of filter materi'l--M--- -----Depth of filter - -----Tota.l . --------------- P-r4e r-- Z_ --- A ____TP_``_____.Distance to nearest lot line_ --- Seepage Pit-. Distance to nearest well/ip.jq ------Distancerom foundafion3............. Number of plits__/---------r-----Lining material______-__ .- .-Size: Diameter__ %ON nearest well-----------------Distance from foundation. ------Lining material___---_--___--------------`------- Cesspool: Distance from .. ..........-Depth-----------------------------I------------------------------------Liquid Capacity-------_-------------------g als. Ir- F1 Size: biometer----- --- -------- ----- ----Distance from nearest building_________._______--_____.__.-------_----- 1E Privy: Distance from nearest well_____---- --------------- ---------- ----------Dis ---------------------------------------- -------- ---------------o:;,F lin r -- Disfance to nearest lotZ---- ----------- -•.- ------------------------- ❑ ' .... -------- -------- --------------- ------------------------------------------------- -Remodeling and/or repairing (describe) --------------- -------------------------------------------------------------------- --------------------------- ----------------------------------------------------------------------------------------------------------- ---------------- ----------------------------------------------------------------- -------------------------------------------- ----------------------------------------------------------------------------------------- ---------I hereby------------------Ila .....have .and, application and that the work will be done in accordance with San Joaquin County ordinances, St c S. lesr.gulations of the San Joaquin Local Health District. ordir r a and r MWEIRM44M(Signed)--- --- --- - - --- ------ ----- Contractor) -- ----- ----- ------- - - ------------- By:-------------------------------------------- ------------------------- --- --- verse side). wells, buildi gs, etc., can be placed on re (plot plan, showing size of lot, location of system i FOR DEPARTMENT USE ONLY DATE-------5------------- --------------------------------- - APPLICATION ACCEPTED BY---------_-_------ .... --- ----- DATE-- ----------------- -- ----- ---------------- REVIEWEbBY----- ------------------------------- ------------ -------- -- --------- ------------------ BUILDINGPERMIT ISSUED---------------------------------------- -----%E------------------------------------------------- DATE------ --------------------------------- ---------- ---------- -------------------- ----------- ----------------------------- ------------------------------ --- —------_------------------- Alterations and/or recommendations: ----- . 's----- ___--___---_._._-__.. -------- - ------ ------------------------------- --------------- -------------------------- -------------------------- ------------------------------------ ----------- ----- . ------ ----------------------- ----------I---------I---- ------ ---------------I------------------------------------------ ---------- --------------- --------------------- ---- -------------------- -------- ---------- ---------------------- ------ --------------------- ----------------------------------------------------- ---------- ------------------------------ --------- ----------------- ---:-------------------- ---- -- - ----- ---- ----- ------- -----------I-------------------- --------------- ----------- -----------------I---------------------------------- ......... .... --------------- ------------------------- ----- ------------------------------------ --- -- FINAL INSPECTION By::7:.:-7----- ---------�C`--------------------_------- Date------- -----2 S_--------------------------------------- SANJOAQUIN LOCAL HEALTH DISTRICT sycamore Street 814 North "C" Street 300 West Oak Street 132 130 South American Street Lodi, California Manteca, California Tracy, California Stockton, California ES-9-2m 145446 ATWCOD 12-54