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11 APPLICATION FOR SANITATION PERMIT Permit No...... (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in. compliance With County Ordinance No. 549. e W" 11 , /__d ------------------------------------------- V LOCATION-e,Z _�Azll ---- JOB ADDRESS AND 7 n�L -114 1/---- Phone-_-------------------------------- '2 -------- Owner's Name----- _j FKe)---------_1-------------------- ------------ JO ---------- Address----------------�,-f ----------------------------------------- ---------------------------------------- ------------------------------------- Name---------------------- --- -------------------------------------------------------------- Phone ------ Contractor --------- mmercal E] Trailer Court F Other.. ........... Installation will serve: Residence 0 -Apartment House Ej GNumber'of Motel a2� Other 0..#1 i /ibaNumber of living units-. A_ Num6er of6edrooms - fhs/e/_ Lot size ----------------------------------------------------------- Private El Depth to Wafer T Z _f Wafer Supply: Public system. El Comriiunify system El able 6P 7 ❑ Adobe ml�arclpan 0_.�- Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam n Clay Loam 0. Clay Previous Application-Made: Yes E] No UD/New Construction: Yes [:] No ED,-FHA/VA: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool perktfed if public sewer is available within 200 feet.) __________.Material_____________________________---------- 5eptic Tank: Distance from nearest well-,----- ----------Distance from foundation__.__ No. of compartments-'--,--..--"---------------Size--------------------------------Liquid dep�h--------------------------Capacity----------------------- Disposal Field: Distance frorh nearest well----- ------------Distance from foundation--------------------Distance to nearest lot line_________________ Len'qt-b of each line-----------------------------Width of trench--------------------- --- --------- rq Number of lines-------------_--------- --------- Type of filter material-----------------77:��&pfh_tlof filter material-----------------------Total length------------------------------------------ __1 e f w' m- foundation--------------------Distance to nearest lot line--------- Disf6-nc - _.t------ Seepage Pit: Distance to nearest well . ? - Depth-,9?0 Y�E] Number of pits-----�?------------L-ming"raferi"01--, _�e7 -Size: Diameter___ ----------- -1 190 c. - --------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__. ---- El Size: Diameter-------------------------- -------�:-----D6pth----------------------------------------------------Liquid Capacity------------------------ gals. Privy: Distance from nearest ----------------------------------------Distance from nearest building----- ------------------------------------- nDistance to nearest lot ------------------ ------------------------------------------------------------------------------------------------------------- --- --- --------------------------------------------------------------- Remodeling and/or repairing (describe):--------- --------I--- - - ------ W-0 I/-- _7 -------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ----------------------------------- -------------------------------------------------------------------------------------------------I---------I_--------------------------------------- ------------------------------------ 1 hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin. County ordinance,, State laws, and rules and regulations'ol the San Joaquin Local Health District, (Signed)---------------------- - ---------- ------------ ---------(Owner and/or Contractor) ----------tivi6k - ------------------------- ------------------- By:--------------------------------------------------- ------- L--- t--------------------------------------(Tit ---------------------------------------------------------------- (Plot plan, showing size of lot, locati f system i re ation-t'o dells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - ---------------- DATE--- --- - ---- APPLICATION ACCEPTED BY---- ------ - -- ------------- --- - REVIEWEDBY------------------------L- - -- - -------------------------------- DATE----------------------------------------------------------- - - ---------------�;------------------------------------------- DATE------------------------ BUILDING PERMIT ISSUED--------------------------------------- ------------------------------------ Alterations and/or recommendations------ - ---- ---------------- ----- ----------------------------------------------------------------------------------------•-------------- --------------------- ....4. ---------------5 -------71-R-to---------------------------------- -------------- -- ------0-:77 -------/)F,_J;7 H....--7----------30--- ------5-- ----------------------- ----------I------------------------- ------------------------------------------------------------------------------------- --------------I------------------------------------------------- ____K..... ---------- ------------------------------- B - ---------- ------------------------------------------------- U�N_t��_vr ---------T,,F;A FINAL INSPECTI01' Y- - Date---------------- -: ---------------------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 11.1, Manteca, California Tracy, California Stockton, California Lodi, California ES-9-2M Revised 1 S7 F.P.00.