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Permit No.�_-.�_ r_ APPLICATION FOR SANITATION PERMIT4 ---------- (complete in Duplicate) Date Issued t for a permit to const Applica4-ion is hereby made to the San Joaquin Local Health Districruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND .LOCATION.----�--��-----=-----�•--�Y7"Y"' -..---- ----`=---•------- - -- ---�.,G��-t✓----------------�--- -_ Phone �s�a -- ------ •-------• F"--_•__-_-- v r lip Owner's Name �r s -- ---•---------------------• ------------------------------------- ---?E' = --------------------------------- lf4--------- / Contractor's Name--.--_-_----------------- =` Other [IInstallation will serve: ,Residence 54 Apartment House El .Commercial L] Trailer Court E] Motel ❑ �C/ LOt,size .---'---S?� .........--f•,�-®- ------•---------- 3 Number of living units: _-__YNumber of bedrooms _- Number of baths .__ --- // Water Supply: Public system � Community system ❑ `Private ❑ Depth to Water Table _'Y'Oft. PP Y� ❑ravel Sandy Loam F1 Clay Loam ❑ Clay ElAdobe K Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ G ��s��rn- d+'y ''�` d Previous Application.Made: Yes E] No K: New Construction: Yes No ❑ a.ft TYPE OF INSTALLATION AND-SPECIFICATIONS: } ailable within 200 feet.) �(No septic tanVor cesspool permitted if public sewer is av 4-+ �._ .,,t,, �_°..t .. ._�.. . .c Ta k: -YDistance from nearest well------- -------`Distance from foundation------.-_-------- M SeptiMaterial__----.---------------- ;< © No..-of.Lompartmenfis- : ------ --------- ---------- ------------- size . Liquidtdepth Capacity - - ... U. Distance from;foundation------------------_Distance to nearest lot line----------------- -----------------------Width of trench--------------------- ------------ Dis osal Feld: Distance from nearest well._..-4----=-- ,Length of each line---__------------------------- ®!$ 1 I? Number of lines----------------------------- Type of filter material-------------------------Depth of filter material---.-------------------Total length--.---•--------- �:- r „ 10---.--.--..Distance to nearest lot line- _:.-. Seepage Pit:' Distance .to nearest well' 0 Liming Distance from foundation_- �a,. Depth -'��, ------- ------- ____J - 1 :. 7 1. Number of pits.--__,-j------=------- Lining material GcY1�----Size: Diameter---. - Cesspool: Distance from nearest well----------=------Distance from foundation--- material----------------------------- Liquid Capacity ----------gals. ❑ Size: Diameter : F - "„ - -Depth----------------------------- -------------------- q p Y ----------------Distance from nearest building------------------------------------------ Privy-: Distance from nearest well �. .. ---------------------------------------- --------- Distance t----------------------------------- -- ------ } - ......� Distance to nearest,;lot line-___- _----------- f Remodeling and/or repairing (describe):----------------= i --------------------------- -------•-- -----------------------------------------•-_••--:---------•-•------ -- - �; --------------'------------------ - .. I herebyF,ry thatI have prep ed this application and that the work will be done.inaccordarsce with San Joaquin Countyordinances, Staws,' avid rul an gulations of the San Joaquin Local Health-District. C t t ± on rac �------------ (Signed) ----------------------------------------- ---------- I --------------------(Ti ,Ynd- O-P, -------- - - ----- -- BY:-•------------------- --------------- = )(Plot plan, showing size of lot, location of system i elation to wellsLn gs, etc.; can be placed on reverse side). FOR DEPARTMENT USE ONLY - ------------------------------------- ---------------------- ----- DATE_. -------- ----------- APPLICATION ACCEPTED BY.- -- ------------------- ----- REVIEWED BY k _ DATE-------�---------------------•----------...------------- ----------- DATE..------ ------------- BUILL . PERMIT ISSUED------------------�-------------- --------•------�--------•------------- � � - -----------•---------•--�-••-------------- Alterations and/or recommendations:--_-:_-.-- w ------------------------- ---------- ------ -----•-------•--- --------------------------------- 41 5 ~` q — � Date--=-----`----~-----------/� .0 FINAL INSPECTION BY- ---------- =--- ......... --------------- L SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street + Manteca, California Tracy, California Stockton, California Lodi, California cc_o,9AA : Revised W-2100