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permit No. APPLICATION FOR SANITATION PERMIT Duplicate) Date issued Complete in 'in described.-' )Cal Health District for a permit to construct and install the work here .5 CD made to the San Joaquin Lc Applica4-ion is hereby ty Ordinance No. 549 Tt is made in compliance with oun Ordinz ------- This application A-e-1---;T y- - ------ --- JOB ADDRESS AND LOCATION-_-- ------ -------------- Phone------------------------------------ ; a _C_taj-d.n_g��-------------------------- --- --------------- -------- ---------_----------- Owner's Im-------- ---------------I--------I------I------------------ ------------- ---------- ----------- --------------- ------------ phone ---- ---- - ------- Address_------- -------------------------- s Name."._-__D ❑ ZY-4--- - ------ -- ---- Court [I Motel E]�_Other Contractor' it House ❑ Commercial 0 Trailer linstallation'wilil serve: Residenc.e..E3 Apartmer baths Lot size ------------------------------ I Number of bedrooms Number of ba Number of living units, I ft. ate [] Depth to Water Tabe Dan ❑ Water Supply-- Public system R t Community system Private 0 Clay 0 Adobe[B---H feet: Sand [I Gravel 0 Sandy Loam 0 Clay Loam k Character of soil to a depth of 3 NoNew Construction. Yes 0 No Previous Application Made: Yes 0 TYPE 'OF INSTALLATION AND SPECIFICATIONS, available within 200 feet.) ol permitted if public sewer is ---------------- (No septic tank or cesspool nce from-foundation_-,.__----__----- ---Material------------------------------- Distance from nearest well-- --------------DistaLiquid depth --------------- ---------Ca pacity----------------------- Sapfic Ta Size------------------------------- . I a - No. of COmP,rtments_-- ------------- ---- ce from foundation--------------------Distance to nearest lot line----------------- Distance from nearest well--._"_.__. __---Distance -.Width of french-- ----------- --------"-- -----�a I�`. of each line"---------------=-----Number of lines--------------- -----Length -.Total length------------------------------------------ epfh of filter material-----_---------- 'Type of filter material------------------ D foundation___/151" of•Dist to nearest lot'line_/_7------ DisfanceArom --------------- ge Distance to nearest well.C5_00_ maferi�� • _Size: Diarnete Number of pits..../---------- --Lining ------------------ -Lining maferial_----------------------------------- t -------------ga]SN. Distance fv,om nearest well_.____ Distance from foundation, --------Liquid Capacity-------------- Size: Diameter------------------------------ -------Depth----------------------- ------Depth-------------------------------- -- .0 Distance from nearest building----------------------------------------- Distance from nearest well--- -------------------------------------- --------------------- Privy: --I------ --------------- --------------------------------------------------------- Privy- Distance to nearest lot line___________________ ------------------ 0 ---I------------------------------------------ ----------_---------------------------- ----------------- ----------- Remodeling and/or repairing (describe)------------------------- ------------- ----------------------------------------------------------------------------------------------- • ------------------------------------------------------------------------------------------ -------- ---- --------I----------------------------------------------I------------------------------------ -------------------------------------------I--- ------------------------------------------------------- ----------------------------I------- -------------------------------------- ---------------------- ---- -------------------------------------- ---------------- accordance with San Joaquin County f. ---------------- and that the work will be done in I hereby certify that I ha4e prepared this application a cal Health District. I re Mations of the San Joaquin Lo ce int I "s P,�4 te laws, andjj�iV jr&C ordinance P%I 7HT Contractor) ice SStic jonk -vice-`=--= ---- -- ----- - ----------- igned -Ser -------- -------------- ----------------- ---K64-7 --------(Title - -------Atp"n'--callif---------- -------- --- - ----- - ------ -- ----- be placed on reverse side). By:_------------------ , location of syste n relation to wells, 6 Clings, etc., can (plot plan, showing size of lot FOR DEPARTMENT U-SE ONLY DATE---------------------------------------------------- APPLICATION ACCEPTED 3y -- --------------------------- ---------------- -- ------------ DATE--_-7-A- ---------------------------------------------------- REVIEWED By- �_ - ------------------------ ------- DATE_ % --------------------- -------------- --- BUILDING PERMIT ISSUED-----------0--- - --------------- -----------------------------------*------------ Alterations and/or recommendations:------ ---------- --------------- -------------------------------------------- i ---------------------------------------------------------------------------------------------------- ----------------------------------- ------------------------------------------------------------------- ------------------------- ------------- ------------------------ ------ ------------ ----------------------------------------------- -I----------------------------------------------- ------------------------------------------------------------- ----- -------------------- ---------------------------- ----------- - ----------- --------------I------------------------- --------- -------- ---- _ --- Date" ------ FINAL INSPECTION BY:--------------- - SAN JOAQUIN LOCAL HEALTH 'DISTRICT 914 North "C" Street 132 sycamore Street 130 South American Street 300 West Oak Street Manteca, California Tracy, California Stockton, California Lodi, California 145446 ATWCRD 12,54