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_-Permit No. _ APPLICATION FOR SANITATION PERMIT (Complete in Duplicated Date issued ------- (Comp " - - A permit to construct and install }he work herein described. Application is hereby made to the San'Joaquin Local Health District fora p lis a in compliance with County Ordinance No. 549. This application is mad _ ._ - - - C7¢ - -d - Phone-- - �p y JOB ADDRESS AND LOCATION-------� ------------------------- _ (f,l, Owner'sName E C1-- _ �- --- ----------- -- Phone Address---- -- '-t -- _�,-¢--.-- - --�..,� -,C�'�---"-------- ------------ _ - - ,��r .,!- - ------ -- "--W Motel Other ❑ - Z Trailer Court ❑ Contractors:Name-"--- p� as ment House ❑ Commercial ❑ e t . k� . �,�-----------�'�- -------------- ment House w+1l:serve: Residence ❑ p .. �' Number of baths _�'- Lot size -",,--jj-��---- Number,of living unit's' 4- - Number of bedrooms .-- De th to Water Table . f} >h �= ' ,r Commuriity system ❑ ' Private p Adobe Hardpan ❑ Water•�Supply:.APublic system ❑` Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ New Construction: Yes ❑ No �HA�VA-, Yes ❑ No ! Character of soil to a idepth of 3 feet• Sand ❑ zk N o I • Previous Application Made: Yes TYPE'OF,INSTALLATION AND SPECIFICATIONS: is tank or cess ool i ermitted if public sewestanceafromefoun+da?oo"fee}.) Materia4-------------------------------- -=--------- ' (No septicp P F ,w Capacity--------------------- 7tic, a k Distance from nearest well D Liquid dap#h---------- Size"-------------------------- �i No. of compartments-------�--- ,�`� e .�/' Width of trench. -`{� Distance from nearest well_. _ea-- -.Distance from foundation-"- --• - -Distance to nearest lot ine� \1, Di osal Field: Dist Length of each line_- �� r � f Number of lines----- Total length_-c t line_"_"_Depth of filter material_--f ' Type of filter material_ Q•___,Distance to nearest lot line---�Q�J- -- L� ! �� Distance from founda#ion------! --•- i De'ptl^ �"-- -------------- � � P};t Distance to nearest well-e— ameter-_"" - ------ Seepage Distance from foundation.- 9 size: Di Number of pits.---l----------- ---Linin material__. {v P�! l`� -----Lining material gals. +EA Distance from nearest well---------- Liquid Capaci#y--------" t Cesspoo : = Depth = ❑ Size: Dajameter--------------------- Distance from nearest building-------------------------------------- < " -----------------"-- --------------------- Distance from nearest we - ---------------------------------------- Privy: + r ❑ - Distance to nearest lot line----------------------------------- - - ,.,� a °� DAY--Bs--L�LI_GHT— _: ----------- Remodeling and repairing {describe]:----------------------------- .- "-- --QEF''TIC-'T"ANK-"SERVICE---------------------------------- 2905 Miner.AV6-,------ � �1StOM5,-Cafi-----,__----- ---" - ------ ------------------ ------- -----------------------� ------140wad-2-_7.0-46-------------------------------------------------- ------------------------------ -- ------ ---- _"_--_-"-_--.- -"----------------- -----""""--"---- -� application and #hat the work will be done in accordance'w+th San JoaquinCount 'I hereby certify that l have prepared this app ordinances, State laws, and rules and regulations of'the San Joaquin Local Health District. . Contractor.] Si ned "-(Title)- -- - --------------------- (Signed) ------- _ ( g a ---- n e ac on reverse side). buildings, (Plot plan, showing size of lot, iota#ion of system in.relation # TMENT USE ONLY FOR DE AR -- DATE-�--------------- -------------- ----- ------------------ ----- DATE-1R "" " --------- __- --------------- ACCEPTED Bs- --------------------- APPLICATION DATE-- REVIEWED By ----- - --------------- BUILDING PERMIT ISSUED _ .^ ------------- ----•----------------- m ndatio --------------- --•--•----- .. .:----- -- -- Alterations a 1. or r :.. . = -"-•-"----1 "-_-- •-" 1 ------ -•--"_ ----------- r .- -_-_.-•_--- ------------------------------ Date_. ---- '------- __. ' I FINAL INSPECTION' BY: r ------UlN LOCAL HEALTH DISTRICT SAN JOAQ 814 North "C• S+ree+ l 132 sycamore Street Tracy, California 304 West Oa4 Street Manteca, California l 130 South American Street� Lodi, California Stockton. California ES-9-2M Revised 1.57 F-P,C4.