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i 37 Permit No ...... APPLICATION FOR SANITATION PERMIT � - (Complete in Duplicate) Date Issued ------------ ------• 4, A .lice+ion is hereby made to the San Joaquin Local Health Distrriicfor a permit to construct and install the work herein described. This application is made in compliance with County Ordinance ��,,// ..0/- ----------------------------------------------------- 71 ADDRESS AND L CATION._f'-.F.- L� ------ , JOB e k - Phone------------------------------------ Owner's Name. i -------• ---- _.v 5PhonAddress• ------ ......... ' -------------.--- -------------- Contractor's Name---- --- ----- ------ ------ ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residi nce �-- Number of living units: ___ ___ Number of bedrooms' imber of baths t-- --- Lo} size __.��?---- --�--=�•�r--�------- •------•- ommunit system ❑ Private ❑ Depth to Water Table TO ft. Water Supply: Public systip y y ❑ Clay ❑ Adobe Character of soil to a depth iof 3 feet: Sand [I Gravel [jSandy Loam ❑ Clay Loam Previous Application Made: Yes ❑ No4--mew Construction: Yes TYPE OF INSTALLATION ND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6lic sewer is available within 200 feet.) , pp III ` Material Septic Tank: Distance from nearest wellf� "�-Dis#ante from fou #iLnI� depth----/�---- Capacity___b-- -• No..ofcompartments----- .� Size., - 97 Distance to nearest lot line---- f �. Distance from foundation_.��-----•-- Disposal Fiei Distance from nearest well ~"� Width of trench-__ _ _. __ Numbe r,of lines----__�----- ---- --4-7- 1 Length of each line------ ----.�-� - ^- De th o er ma ial .�--Total length----.?-•-------------•------------- Type of filter material--1 p !� / Seep ge Pit: Distan c to nearest well_�"I Distant 'f �Ou_;, a ion___ !-'�-------Distance to nearest lot line_-+ ------- Number of pits----- ------------Lining material_ _ Si e: Diameter ' t llhCesspool: Distance from nearest welk-----------------Distance from fou anon.__._-_._---__----Lining material-----._..___--------------------als. ❑ Size: iiatneter--------------------- - -------------Depth------------------------------------------ Liquitf Capacity------------•- 9 Distan�C�e from nearest well------------------------ --------Distance from nearest building------------------------------------------ Privy: -------------- ❑ Distance to nearest lot line----------------------------- ------------------•--,----------- --------- -------------------------------- - Remodeling and/or repai�`ing (describe):----------------- ------- ------------- -------------- I�I -----------------••-------• -------------Al---------- ----•------------- -------------------------------------- - -------- - ---------------•- _-0- --•---•-----•--------------------------------------------•-----------•------------ I hereby certify that�l have prepared this application and that the"work will be done in accordance with San Joaquin County ordinances, la , and and r ulations of f San Joaquin�Local Health District. riontracforl Signed)_. ------ ---------- -- ------------- ---------------------------(Title z } (Plot plan, showing size of lot,_location of system in relation to wells, buildings, efc., can be placed on reverse si e. �Ih FOR DEPARTMENT USE ONLY of ;. r DATE —---------- _3.-''�. --------- APPLICATION ACCEPTED BY___-------------- DATE--------------------- REVIEWED BY------------- --SIB---- ------ -------- PERMITISSU�I�D-••---•----------------------------------------------- DATE. - --------------------------------------- BUILDING Alterations and/or recommendations:------ ----------- --------------- ------------------------•---- - -••---•------------•-------- ----- 1 --------------------------------------- --------------------------- --------------------------- �h --- ----------------- -------------- ---------------------- FINAL INSPECTION I Y--------------- -- ------------ Date--------- ----•- ------ - - 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, Gelifornie - E5-9-2M 115446 PT131- I 12-54 i