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� r JJ , 5 APPLICATION FOR SANITATION PERMIT Permit No. -v.l- --.-•.. 11� i (Complete in "JupHcata} pate Issued � �.:..�� M. Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. "al a This application is made in compliance with County Ordinance No. 549. y ti ;;w� Q •: : .::.. 1 -: - . .................................................... JOB ADDRESS ANDJ� CATION.... +'- r Ph-, one........ .............. Owner's Name.. e3_f•.. /. �rC- `tt a - / — .. Cl ;,. Address ' .ff. ................. ............_._ ..�. Phone.?..� ....�i 1............ Contractor's Nems..... ._ � Othe •�� Apartment House [D Commercial ❑ Trailer Court CI Motel ❑ Installation will serve: ,Residence F1P .s f NNumber of living units: .. Number of bedrooms ........ Number of baths ........ Lot sizo ..................... Private Depth to Water riTabley6. ft. A Water Supply: Public system ❑ :Community system ❑ P C ❑ y ❑ Adobe Harden Character of soil to a depth of 3 feet: Sand E] Gravel C1 Sandy Loam Cla Loam .ay❑ P [3 O Previous Application Made: Yes-E] No 9 New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a? ._. t; p 'crTank: Distance from nearest well...........:.:rDistance from foundation............,......Material........................................... • is _ _..-..�...... ..............Size Liquid depth........I................Capacity............._......-. No. of compartmen4s__... S r/ Distance to nearest lot line...t .-- .... S Isposal ioId: Distance from nearest we�J..�60,..-.-Distance from faundatwn. ,� ., Number of lines........-�.::.:............ . Length of each line...f .--•••-:••••' Width of trench......�y.................... i. }}. Depth of falter meter,al..f�..-• . '..••Total length...... ...o:.G............. ..�..- Type of filter material.. ••- .. 4 ee Pit: Distance to nearest well......................Distance from foundation.:_._.....-_:......Distance to nearest lot line................. .Linin material_._. Diameter. .Size: ......................Depth.......................I...... s Gb � Number of pits.................... g Cesspool: Distance from nearest well.................Distance from foundation :_.....Lining material.......................... . L, wd Capacity gals. , ............. ... p ty....----- i ❑ Size: Diameter......................................Depth...._........._ q ( . ...................s........Distance fromnearest building._............_........................` r Privy: Distenco from nearest well.,................. "'`•� ................................................................. L I © Distance to noares+ lot line. .................................../;... Remodeling end/or repairing (doscribo) s.. ••.•.•...-•.......................... - ... .............. ....... ....................................................................................................... ........_....... ........:. .................. ...................... ............................................ 5 I here13 certify that I have prepared this application and that the work will be done in accordance with San Joaquin County y t: c ordinances, Stat laws, and rules and regulations of the San Joaquin:Local Health-Distrtc . M - Contractor) (Signed)...._. �/or ...... ........lf�S1ner [Tile.._. . n .. (Plot plan, showing size of lot, location o0systern in relation to wells, buildings, etc., can be placed on reverse side). _ (, FORMEPARTMENT USE ONLY T z DATE......_... f :. ..��. ...r.......... 1n J�S,�t. ...................... ... f4- �' APPLICATION ACCEPTED BY.............................. f U� . � DATE.....................................................:..... ...... ..............._T-.. .. REVIEWED BY................................................... : • - .._.. DATE............................................................. } j .. ,._............................... BUILDING PERMIT ISSUED...... .............................................. ..;. Alterations and/or recommendations:................_1....,_-.._. .- ........._____................. r t ....:............................... ..-.-- ........................... .............................. _ ....................... i ................................... .. .................... �...•...�... Dete........--•...: . f................................................ FINAL INSPECTION BY:.. ..............l .......-:. SAN JOAQUIN LOCAL HEALTH DISTRICT -'A 132 Syumorr Street 014 North ••C••Strrrt -' 130 South American Strret 300 West 0a4 $!reef i • Manteca, California Tracy.Tracy. California Stoetton, California Lodi, California ES--9^2M' ' Revised YJ•2100 C I�