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r Permit No. ------- f. . SANITATION PI=RM17 APPLICATION FOR• , Complete in' Duplicate] Date issued --� - `� Y �! � n Joaquin Local 49, Health District fora .permit to construct and install the work herein descri e . o Application is hereb made to the Sa q z Y l+ca#ion is made in compliance with County'Ordinance No. 5 This app `'`' r r - , JOB ADDRESS A LOCAT N_._._ -f Phone_ { . ; ---------- Owner's Name-- ----- -'-�------�- � : - -- - ----------------------------------- •--� - ------------•-�--=-- ----•--•--------------•--- _ ------- Phone---••---• -•------ Address------•---- -- � ----- - - --- -�--- ----------------------------- --- ---- ----- --------------�- r Othe ❑ , -�---�- /- -Q =�`-" ------ Trailer Court ❑ Motel ❑ 1 Contractors Nam lJ IA Apartment House ❑ Commercial ❑ A f � -------- Installa#ion will serve: Residence p '� Number of baths -1----- Lot size _-- ------- Number of bedrooms _ -_- Number of 4iving units: ---- --- + Private ❑ Depth to Water Table -------- ft w ardpan ❑ 'Community 5Y Clay Adobe Water Supply: Publi system 1 Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ n ..� w Construction--- Yes�L�S Y'S° ❑ �.FI lA/VA:•Yes� ° Character of soil to '!depth of 3 feet Sand Ne Previous Application Made: Yes El No . . TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank-or`cesspool:p rmitted if-,public sexr�sta ave{oblefouhin io0lo_�ateri. I ------•---- ( , ��, y +• � _Capacity----- - Ditance fromxnearest well___- -�i `_ t +.Liquid depth - Septic ank-. •w—. tZ_'---- Szed -- ; / ----------------- - No, of com artmen`ts___-_._,y - 4�i tance to Bares# lot lme-- p �� ----7- pZance from founda'tf on__ x Width of trench- - -- DisposalrField: DVance from nearest well Ingth ofeach line___ ___ _Ntuber of lines:----- pthof filter material---------1- Total !�t� TOO lJ ' istance to nearest lot line------------ Type of filter- -,�� Distance to nearest we l__-__._- Distance fromfpundation_________________•-. ,. Seepage Pit: Linin material11 Size: Diameter _ - .Depth_ - , Number of pits.-------4--- g s '>yty g t` - l-------------------------------- - -- - Liquid Caprial- gal .� ! . � ❑ - , � _Linin mat aCit -------------------- ------- \] Distance from nearest well-----------------Distance from foun attion__ --- - y-._.___.__- " Cesspool: -- b _ Depth---- � -- --- Size: Diameter------------------------- -r--Distance from nearest bu+4d+ng-- ------ ❑ --- --------------------Distance from nearest weiL------------ ---�---- --- -- -- - - - - : r �(,Y ivy: -- ------------ Distance to nearest lot line-------- , €. ..f ---- ❑ t ------ k r __________________________________________________ _ Remodeling and repairing:(describe? ---- ------------- .- Y ---------- ------------------ ---- -------- ---------------------- ______________________________ - ____- ________________________________ ------------- ------- __.______..____�____._._.____._._ application and the#the work will be done in accordance w+#h San Joaquin County this app ------------------ --- - ---- ---- I hereby certify that I have"prepared ulation3 of the San.J6aquin Local Health District. or Contractor( ordinances. State laws, and rules and reg ---------------(Owner and/ - ------- (5igned)�- r - - - -- - (Title)----•---------------- - ---•---------------------------- ------- .� r Sy----------------------------------- (Plot plan, showing size of lot, location of system#in relation to wells, bu+�dings, etc., can be placed on reverse si e. FOR•DEPARTMENTiiA`VbNLY.-- - DATE ------- ------ --------- --------- ---- -- r --------------------------- APPLICATION ACCEPTED BY--- -------- ---------' -------;------ ---------------- --------- -------------------- --- DATE---.. ,..�_._ --------•-------------------------; REVIEWED BY------=----- -------------- - � .. DATE""_-- --- BUILDING PERMIT ISSUED----------------- ------------------ ' --------------------------------------------------- •--------- ---------- Alterations and/or recommendations-------- -----= ------------------- ------------- - ----------- --------------------x------- ---------- - ------------ •--- ;" �,.- ----- Date_ -- ---- ---- ---------- --- _ --- ---------- FINAL INSPECTION SAN .JOA LOCAL HEALTH DISTRICT 814 North "C" Street 132 Sycamore Street Tracy California 300 West Oak Street Manteca, California 130 South American Street Lodi, California 4 $}ockton, California + FS-9-24A Revised 1-57 FRCO-