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` FOR OFFICE USE: < --------------- Permit No. - APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued - �� -------- -------- -------- - --------- - This Permit Ex ices 1 Year From Date Issued d. Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein descrMibe ^ This application is made in compliance with County Ordinance No. 544. a .[` y / e7c= (f . UNA ----- � --el 9xo) -- -� - ------JOB ADDRESS AND LOCATION I) Phone Owners N e ------ �-------- --------------- t�r ' 1----- -- . _------ --- ....... -------------------------------- --------------------------------- Address -----. Phone----------------------------------- Contractor's -------- ------------------------ Contractor s Name-- -� -------------------------------------------------------------------------------------- 11 Installation will serve: Residence Apartment House-E] Commercial ii E] Trailer Court ❑ Motel [IOther ❑ Number of living units: - ----_ Number of bedrooms 3--- Number of baths ____L,Lot size _-_�C9�--------------------- Water Supply: Public system ❑ Community system ❑ Private ;g D�pth to Water Table -h ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam El Clay ❑ Adobe ❑ Hardpan E] Previous Application Made: (If yes,date_..________________) No ® New Construction: Yes E] No �NA/VA: Yes ❑ No ; 3 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: , Distance from nearest well_________________Distance from foundation_____-__________--Material__:_-.-_________:____..____________..__________. Liquid de th--------------------------Capacity I�t�T No. of compartments--------------------- --Size----�=------ ---------- -----• q P. ----- --------------- 1 I ` l -.--______.Distance to nearest lot linea______________ Disposal F �yC Distance from nearest eli-.�---_._Distance from foundation_ ; TNumber of linesI---- -:_--(-------- ------------Length of each lime------�� r{------.Width n trench.---- �,--.r,--------------- G ---Total length �r D YP {aterial- F0 --,-Depth of filter ma Type ----"--- g See a ee Pit: Distanoceftoen nearest well___________.--______Distance from foundation____________2°'___-'Distance to nearest lot line_.______________ I ❑g. Number of pits:+-------------------Lining material---------------- Diameter Depth --------- Cesspool: Distance from ynearest well________________Distance from fdundation---------__._.---- Lining material------------------------------------- . Size: Diameter-------- --------------------------Depth------------------;------------ --"--------r----- Liquid Capacity gals. IJ -.-Distance from nearest building-------------- --- ------- Privy. Distance from nearest well-------- ------------------------ ❑ Distance to nearest lot line-------------------------------------- ------=-------- ---------•---- --------.---------------------------------------- Rem deiin and/or egairinq (dasc ibe) d .�7� 111---------- -------"t_-e-/9-0--�--- = ----------------------------- --�$ - " E _______________ ------------------___________________-_____________.___________-_______.___------------- - % -------------------------------------- -------------------- ------------------------------------------------_-----------------------------------------------_-------------------------------------------------___------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations f the San Joaquin Local Health District. ( C =-_(Ow _ -and/o S ontractor) -Z--;— St ned �' = __.--_ -- net C . _ ( fig )-------- --4 _ - - -------------- -- Plot Ian, showing size of tot, loca4ion of system to relation to wells, buil-"__ - -fc {Ti#le�____ ..._________________.".-- - _-------- - ( p 9 buil dings, etc., can be placed on reverse side. ,1 FOR DEPARTMENT USE ONLY GG APPLICATION ACCEPTED BY_----'rc--E� a- ------------ ----------------- DATE------- -- " 1'Lt--46----------------------- f -------------------------------------- DATE $- ---- DATE------------------------------------------------------------ fREVIEWED BY-------------------------------- --------- --------------------- ---------- --------------- ; I BUILDING PERMIT ISSUED------------- ----------------------------------------------- - DA•TE------------------------ -------------------------------- -- Alterations and/or recommendations:-_--__.___________________ _ ------ - ---------------------------"---- ------------------------------------------------------------------- -------------------------- --------- - .. -- ---- ----------------------i------------ ------------------------------------- -- --- Date------ ----- --r-- - ---- ------ . FINAL INSPECTI --- -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California Manteca,California Tracy,California Stockton,California � , F.P.C O. 4