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No. APPLICATION FOR SANITATION PERMIT Permit .... ... (complete in Duplicate) Date Issued District for a permit to construct and install the workj3erein described. Application is hereby made to the Son Joaquin Local Health made in compliance with County Ordinance No. 549. This application is I - .11 --------------- -1 A),�- 1--,)L"—C---y------ --------------------- - JOB ADDRESS AND LO T10- --------- ----- - 4&A-4t'r )� Phone---------------------------------- Owner s hone---------------------------------- Owner's Name------------------ -- ------ --------------- ----- ------------------------------------------------ ------------- - - �r- ------ ------- -- - --------------------------------- ---- Address_-................1_7 Phone---------------------------------- Contractor's Name------- --•--•-------------- !House ❑ Commercial ❑ Trailer Court Other 0 on will serve: Residence Apartme 640---------------------- Installati --------- -_ Lot size -qV - ---- ----- Number of living units: __9_____ Number of bedrooms ---7-/ Number of baths .1--- 4t Private X Depth to Water Table ---- ft, Water Supply: Public system El Community system [I 3 Character of soil to a depth of 3 feet: Sand F1 Gravel 171 Sandy Loam [I Clay Loam 0 Clay ❑0 Aclobalo. Hardpan 0 Previous Application Made- Yes E] No A New Construction: Yes X, No E] TYPE OF INSTALLATION AND SPECIFICATIONS- available within 200 feet.) (No septic tank or cesspool Permitted if public sewer is d ion----8------------- - ------------ ----------------------------- arest well--:3-n-o-Distanc orri foun at 0-0------ Septic Tank- Distance from nearest - r, X_ apacity... No. of compartments----------7------------Si __S�'_Liquicl depth------------- ------------C ___...Distance to nearest lot linf,_,5 14 3----0--O-.Distance from foundation----- Disposal.Field: Distance from nearest well------ ---- 40---R,-------Width of trench----13-0 ---------------- Number of lines---------/---S_T------------JT ength of each line_---------- --------Total length--- Ca A - Type of filter material------------I- 4Mepth of filter material I_g.. earest lot Ii Seepage Pit Distance to nearest wejj_--------------------Distance from foundation-------------------Distance to n ........ D ---------------------Lining material e from Size; Diameter-------- ........ .----.Depth-------------------- Number of pits- from foundation____...-------------------Lining material------------------------------------- Cesspool' Distance from nearest well_________--------Distance ....Liquid Capacity_--------------------------gals. ----------- ----------------------------------------- El Size: Diamefe-r----------------------------- nearest-6uilding------_------------------------------- rte. Distance from ne Privy: Distance from nearest well___- --------------- ------ Distance to nearest lot line__--________________________________ ------------------ ------- -- --- ------------ L Remodeling and/or repairing (des, -------------- ------- �4---t�.o J.-OW- -------------- --- -------- ------------- ----- - -------------- ----------Z011 4!xet-,C� _6 ---- -------- - ----------- __ - __ e-"(A with San Joa ui C nfy ---------------- that the work wi onco ------------------- k I done in accord I hereby certify that I have prepared this�applril tion an e ItH District. ,,s, and rules and ulations of the San Joaquin Local and ordinances, State law (Owner and/or Contractor) ----------- .... . ... (Signed)------- z 0,./ -- - - ------ --------- - ---- ---------------------------------------- ------- -------------------------(Title)---- ------------------ --- -- - ------ ---- ------ By:----- ------- ------------------------- ---------------------------in-_relation,-- -to-wells buildings, efc., can be placed on reverse side). (plot plan. showing size of lot, location of system FOR DEPARTMENT USE ONLY % --------------------------------- -- ------ - ------------------------------------------------ DATE------------------(-------- APPLICATION ACCEPTED BY- DATE------- -- --------------------------- I --------�1� REVIEWEDBY------------------------------------- 4i � - -------- DATE-------------------------------------------------------------- BUILDINGPERMIT ISSUED----------- ------ -- ------ -- -- --------------------------------------------- - ---------------------------------------- -------------------- ---------- Alterations ---------------- Alterations and/or recommendations-_-------� -7---------------------------------------------------------------------- ----____ --------_ -------------------------------------------------------------------------- ---------------------------------------------- ---------- ------------------ ----------I-------I------------ ------------------------ ----------------------- ------ ------------------------------------------------------ ----------------------- ------------ --------------------------------I------------------------ ---------------------------------------------------------------------------)---- - ---------------- --------------------------------------------------------------------------------------------------------- ----------- --------------------------------------------- --------------------------- -------- ---------- FINAL INSPECTION :-------------- ------; ------------------------------------ ------------------------ ------------------------------------------------ - - Date-- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 130 South American Street 300 West Oak Street 132 Sycamore Sfreat Tracy, California Sfockton, California Lodi, California Manteca, California cc -o—im io_,,o Revised W-2100