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e7 APPL[C TION FOR SANITATION' PERMI Permit No. = ` (Complete in Duplicate) g�`f1 Date Issued ._'I.----�--7-----• ,K Application is hereby made to the Son{Joaquin Local Health District for a permit to construct and install the work herein described. ade in complianceAwifh County Ordinance No. 549. This application is m y JOB ADDRESS AND L CATI'ON__-I----------- -- --- ------------------i,--•--- e -'------- ---- -_ -} Phone_ _ �- Owners Name- ---- ----------- -- ---------•- ----------•----•------------------ -------------- Address------------------ on --- ---- - --------------------------- -- ' ------ Contractor's Name--------------•--- a i ---- Commercial Trailer Court [-] Motel El. Other ❑ Installation will serve: Residence Apartment House ❑ ❑ l �5� �� S� Number of living units: -- Number of bedrooms Number of baths _-/-__ Lot size __ __._ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 7P- ft. I "' - Cla Loam Clay Adobe�ardpan ❑ Character of soil to a depth of 3 feet,* `5a`nd E] -- Sandy'"Loam ❑— Y y ❑ Previous Application Made: Yes ❑ iNo [ New Construction: Yes ❑ No �HA/~/A: Yes ❑ No �� TYPE OF INSTALLATION .AND SPECIFICATIONS, [No septic tank or'cesspool pe�'rmitted if publi;sewer-is available within 200 feet.)/ � Distance from foundation__. ---- Maters !___________------- �'" _ Septic Tank: Distance from nearest well____________ ___ a `-- -Capacity No. of compartments_.-____._-2_____- ._Size__ ��6__ 3 ----=-••Liquid dept)}-_____�---- l � l t i Disposal Reid: Distance from nearest well---- Distance from founds n__ ------ --Distance to nearest lot line____--a�____.___- Number of lines-----I-1-----------��-jj I - -Length of each Iine___._-S7--------`---f--Width of trench_----v-��--------- Type of filter material__S�_�T ----Depth of filfer material_____f-�_____--.Total length..-- ---------- ,,,. { D•_�-..Distance to nearest lot line___•5________-. Seepage it: Distance to nearest wel{_ -f-- '---Distance from f undation---- /P Size: Diameter_j__3_3:-�.- ---.Depth_-_, =S------ �1 I --- Number of pits. �-�_______________Lining ma#erial___ _ --_ -" .. I' � foundationimaterial_ Cesspool: Distance from nearest well_____;--------- Is from ._____----- -'Li nui.d Capacity gals. ; ---Depth_.__---F----------------------- --------------- q P Y ❑ Size: Diameter__----C. -----�- ---,----- --- est well- Distance,frpm nearest building-________-_-._____________-______-____. Privy: ------ ^ =- Distance to ea est lot line---- ------------ ----------------------------------------- -------- ❑ I n f •--•- ------•---------. Remodeling and/or repairing (desc be): - - _ ---------------------------- --------------------- ---- ----------- --•-- ---- ----------------------------------------------------------- --------- --------- ---------- ----------- --•---- ---------------I-------------------------------------------- i t ---------------------------------I-------- - 1. i ---------------••------------------------------------------ I hereby - ------•- ----------- - certify that I have prepared this application-and that the-work-will-be Aine in"accordance with San Joaquin County ordinances, 5tPews, and rules a'd regulations of the San Joaquin Local Health District. I Si ned �� "----------------------------------------------= -- -{Owner and/or Contractor) [ g ) � ---- ------ - } {Title) By:----------------------•------ (�(� [Plot plan, showing size of lot, location of system in ration o'welis, buildings, etc., can be placed on reverse side). FOR.DEPARTMENT,USE.ONLY--.---.—.IR ' APPLICATION ACCEPTED BY----`-------------- --------- --------------- " _- ---- DATE ------ �s -----------•---- �` t��"' DATE---. .--- ---------------- REVIEWED BY------------------------------- f-=--------- DATE--- ---------------------------------------------- BUILDING PERMIT 1SSLl ED__'_------ -r-------- Alterations and/or recommendations------------------------------------- ----- - ----------•-------------------------•--- ______________ _________ ___ __ _ I' I,, ------------- ------ -_-_______- -------------------------- - 'J L�'-.1i',, ----------- Date:__- . .----- --------- --------- J- - - FINAL INSPECTION BY:__-_ .-."--------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 136 South American Street Manteca, California Tracy, California \. Stockton, California Lodi, California ES-9-2M Revises 1.57 FY-CO. ! s.