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FOROFFICE USE: - ------------------------- ------------------------------- -------------- ------------------------------ ----- ------ -- -- ------------------------_----__-:-_. APPLICATION FOR SANITATION PERMIT ,Permit No. ,l ---------- -------------------------- --- - plicate) ` ------- ------ This Permit ExRnilrese le YearFromDate Issued Date Issued __#�Il Application is hereby made to the San Joaquin Local Health District for a permit to constrruct'and install the-work€herein described. This application is made in compliance»with Count 3�rclina e No: 544, r w � ) JOB ADDRESS AND LOCATION f® l/N-1-0y tT N �G'Vc�Ac t T " � � - -� ---N �`�'p Owner's Name L c2�+ =L�"L✓ _).- _R Phone' M -. --- Address C]�-------- � !�1-r� `- Contractor's Name....A XTVCA .S6p-nom ��-1 C`� = Phone ---------- •---- Installation will serve: Residence k ❑ Apartment Hoomommercial ouse C [-ITrailerCourt E] Motel [:1 Other El ' Number of living units:-L.---- Number of bedrooms �. ---- Number of baths -_-.- Lot size __--�C_1�_I<R_�-�----___. Wafer Supply: Public:system ❑ Community system Pr4%v6fe ❑ Depth to Water Table -� ft:. • Character of soil to a depth of 3 feet: Sand [)Gravel ❑f S��New ndy Loam E] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dole______-------------) No ,Construction: Yes m�No ❑ FI IA/VA: Yes ❑ No TTYPE-„OF INSTALLATION,-ANp_SPECIFICATIONS:.�- (Na septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic'Tank: Distance from nearest well-----------------Distance from foundation.- ------------Material-----_------_`_---------------_---_-- _- STI N(S- No. of compartmenfs------ --------------- ---Size-----------------------••-------Liquid depth----------------- ------.Capacity-----------•------- Ui -� . _�.�.. .... Disposal Field: Distance from nearest well--__-______-_--_Distance from foundation-------- -----_---Distancetto nearest lot line------ fEX ff> )14C,_._. Number of lines:ti-__-___ --- ---------------Length of'eacli lire-_--__: �-- ---iF-----Width of::.tr�ench-.-.--z ” �} Rbh Type.of {filter material--- OCl __-____Depth of fitter mate'rial___--- ---------Total length-`--- f_ ____-,___- £. 4... f r .. t ------ Seepage Pit: Distance to nearest well. o------__--_Distanc. from foundation_-JO-_----_i _ istance to nearesflot fine---_- 19f�f), Number of pits----1-------- -----Lining material--K-0-CK- . Size: Diameter �r 7l. Cesspool: Distance from nearest w) it . Qistance_from„foundation___--.-t-_-______-.L-I Ing aYerial- € .- , t 1 gals. ! ❑ Sze: Diameter_ 6 ------Depth------ --------------------•------ -----------------Liquid jCapacitY---------- ---- g Privy: Distance from nearest well---------------------- ---------------------------Distance from nearet buiiding:(_--;----,- 1 ❑ Distance to nearest lot line - -�---- /• ------ -- - ----- 14 - el Remling and/or repairing (d4criljeT79: �_+- f / !✓ 1�/� Ct -.__ a ----- 1 ----- 1� ,3r�1 c f -------------� -----~- —__' n1 -- = Q `------OF----- ��t� `= �s�vG�-- - ��m�-_ �_.: _� _ ' herebycertif that 1 have - - prepared this application and that the work will be done in accordance with�San Joaquin County � ordinances, Staffw , and rules and regulations of the San Joaquin Local Health District. (Signed) ---- ------------------ -----[Owner acid/or Contractor) ',� y-------------- ------ --�•. �:r-•c ------rsK::- (Plot plan, showing size of of,Jocafion of system in relation to wells buildings, etc., can be placed on reverse.slde. t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- 77'7_-?,.40 " ------------------------ ------------------------------------------ DATE-- - ------- - - -- --------------------- REVIEWED BY -------------------------------- -----I--------------------------------------------------------- DATE-- ------- -------•- BUILDING-PERMIT ISSUED--=-------------= ------------------------------------------- --------- DATE Alterations and/or recommendations:--------------. - -•-------•--------------------------------------------•---------- rt _ ==---, _ --------------------------------"-------- FINAL INSPEC. -- ------ ----- - - -------- Z. Date-.- Z SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaselton Ave. . 3.0.0 West Oak Street' 124 Sycamore Street 205 West 9th Street Stocklon,California F Lodi,California Manteca,California Tracy,California ' ES 9 REVISED 8.59 31A 3-'63 F.P.DD.