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V,,� APPLICATION FOR SANITATION PERMIT Permit No. '14qev i k (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health Dist for a permit to construct and inhe/o'r0described. herein This application is made in.compliance with County Ordinance No. 549. L1�1 CG_l51A ----------- JOB ADDRESS AND LOCATION_0 __ T: ------ Owner's Name-------------C�5T------------j _ -. a�_------ --------------------------------------- ---------------------------------------� Phone -{-S'-- � -,. --------- -- ------ Address b`� l`�~T ------------------------------- Ph one. Contractor's Name__.-'_ v Commercial Trader Court ❑ Motel ❑ Other ❑ Installation will serve: ResidenceApartment House ❑ ❑ r� Number of living units: ---)--- Number of bedrooms ___ Number of baths Lot size ------------------------ ------------------------------------ "�[ Water Supply: Public system [ Community system IBJ Private ❑ Depth to Water'Table ------- ft. i �- ` Gravel Loam ❑ Clay Loam ❑ Clay ❑ Adobe � Hardpan Character of soil to a depth of 3 feet: Sand ❑ ❑ 'Sandy Foam r] Yes ] No ❑ Previous Application Made: Yes ❑ .,No &/ New Construction: Yes [�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted,if public sewer is available within 200 feet.).`„ w ______Distance from foundat'son �________ Maternal__ ._G...---- Septic nk: Distance from nearest well '.5.5------- ----Capacity--- --- �Q Size_ Li uid de th _---- ----- No. of compartments------.-_ ------- q p i Distance from foundation-__.�_0---------Distance to nearer ea - Disposal Field: Distance from nearest well ______--. � } �' Width of trench_ 3✓�----- ��.- ----------Length of each line -- Number of lines__ ___________ ff T g ----------- Type 6 ---- Q Total length -- Type of filter material__�Qc_l -- Depth of filter material_____-lp- ------ ► -__.______-Distanfje to nearest lot line!___------ Seepage Pit: Distance to nearest well_ ------Distance from foundation-- Number of pits----Z_.-------Lining material--- Diameter___��3 ---------Depth-.- - - ing Cesspool Distance from nearest well_____-_-'______--Distance from foundation-__------ -Liquid Capacity gals. ❑ Size: Diameter_;I------- ---------------------------Dept h------------------------------------- .---- Distance from nearest well_______.--____._-____--------------------------Distance from nearest building__---,----.------------------------------ l Privy: ----------- ❑ Distance to nearest lot line- --------------------------------------------------------------------- I -------------- --------- ------- -- --------------------- ------------------------------ ----•------------------------------------------------------------ Remodeling and/or repairing (describe):__-___._______.____ -_---- s -=------------------- ----------- ------------------------------------------------ -----------------------------------------------------------------------------------------•-------------------------------------- that I hereby certify that I have ands egulations olf the Sant oaquinhLocalkHealltheDistrictn accordance with San Joaquin County ordinances, State , (Signed) -------------------- -----------------------(Owner and/or Contractor) Title (Plot plan, showing size of lot, locajion of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY q DATE-------+ -'�L _'`ate/ -------------------- APPLICATION ACCEPTED BY------------n-R-'-Q-------------------------------------------------- DATE------ ----------------------------------------•------------ REVIEWEDBY----- ----------------------------------=------------------------ DATE ---------- BUILDING PERMIT ISSUED_. - ------- --------- ----- ------------------------------- -------- _ f------ - ----------- -�-. -----=---------- Alterations and/or recommendations:__.__------ ------ ---------------- -1_1 T------1_-�fir(----------- ------------------------------------------------ ---------- ----- -�xr - 1T` 7 -1- ----------- - - ------a------ -- ` -- ---/po-------- -----O-� ---- L� ------ 1 - ---------------- - - ----------------------- ---- - --- --- ---------------------------- - ----- ------------------ - ! Date-------- L�/ r ----------- F1NAL INS ---- - -- � ----- - SAN JOAQUIN LOCAL HEALTH DISTRICT 360 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street 13o South American Street Tracy, California Stockton, California ' Lodi, California Manteca, California y' _ ES-9-2M Revisep 1-57 i=.P.Co'