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-------------- --------------------------- ---- ----------------------------------------- ------ ICATION FOR 'SANITATION PER Permit Permit No. - - ---------------------------------!------- (Complete in Duplicate) --------------------------------------- .1 -------------I------ This Permit Ecpi•res I Year From Date Issued •Z 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.Oiclinance N 549' O$ ADSAND19CATION - - --------------------- --------------------------------------------- 11ner's Name-------&-ek2_7........ I I A;. t Address----------------------- -1-----I- ------------------------------------------ ...................... ........................... Contractor's Name ----------- --------------------------------- --------------------------------------- Phone----...----- ------------- Installation will serve: Resjd� BnCO [tr'- A—Partmerif House E] Commercial El Trailer Court E] Motel C1 Other El Number of living un 41s: Number of bedrooms �--- Number of-batV--------- Lot size .._-:--(5 -----X.1.1�)_.__;?11/ Wafer Supply: Public systellm 0 Community system [] Private Er &pfh to Water Table ft. Character of soil to a depth of 3 feet. Sand El Gravel Ej Sandy 11 Oam C1 '`Clay Loam D Clay n � Adobe 0"Hardpan ❑ Previous Application Made- (If yes date-------------_---- Q3, "I� ) No e, Construction. -Yes El No Fk�HANA: Yes 0 No TYPE OF INSTALLATION AND SPEC I FICATIO NS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_- ---___ --Distance from foundation-------------------.Material---------- Y-21/ ------- -------------- No. of compartments----- Size------_------------- e_�__Liquicl depth--------------------------Capacity----------------------- Disposal F d. Distancell from nearest we'll_.A�P.........Distance from foundation---I.,d -4 If Number!1of lines.......... __1........Distance ;to lot line-- -------- ............... -----Length of each line. _,;:� / 2U--- -------------Width of trench------ Type of filter material---)-��_AwDepth of filter maferia -------------- I------ Total length---------------71�__ / . Seepag ----------------- e Pif: Distance i�Jo nearest well-----------------------Distance from foundation----------_------Distanceto'nearesf lot line----------------- ❑ Number,6of pifi---------------------- Lining material--------- --------- -,Size Diameter-----------------------Dept h------ -----------_--------_-- Cesspool: Distance from nearest well-----------------Distance from found a t'i'on____-------------Lining material.----__-.-- ---__._ El Size: Diameter--------------------------------------Depf h--- --------------- Privy: -----------------------------------Liquid Capacity..............._-----------gals. Disfance,.from nearest well ❑ Disfancellito nearest lot line-- - ------------------Distance from nearest buil.ding--------------------•------------------ ---------- ------ ttt --------------------- ------�7-------------------------------------- -------------- ------------------------------ Remodeling and/or repairing (describe):------------------------- -----------------i�---------------- -------- ----------- ------------ ----------------------- /--------- ------------------ ------------------ ---------------------------------------------------------------- -------------- ------------------- --- ------- ------ 11 --------------------------------------------------- 11�11-------------------------------------- ------------------------------------------------- --------- ------------ -----------------------------------•---=----------------••---------•--------------------------------------------------------------------------I---------------- A hereby certify that I h'lve prepared this application and that the work will be done in accordance with San Joaquin County wdiAances, State law nd rules and r u ti I a" Ion f the San Joaquin Local Health District. Dr, or (Signed)----.------ ------ - -- ----------- ---------- 0 :----------------------------------(Owner and/or Contractor) By:-------------------- 6---e----- ------- ----- -- ----& (Plot plan, showing sil lot I, loca - k . .......................................(Title)------ --- ------------- tion of system in relation to wells, buildings, etc.;, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED El A -------------------------- DATE------ REVIEWED BY iE77T-_ ----------------------------- -------------------------------•---------------------------------------------------------- DATE....... BUILDING PERMIT ISSUED---I---------------------_----------- --------------- --------------------------------------- DATE---------------- Alterations and/or recommendations----------------- l -------------------------------------------------------------------------------------- ----------- ------------•-----------•------ ---------------------------1------------------------------------- ---------------------------------- ------------ ------------------------------I----------------------------------------------------------------------------------------------I--------------------------------- -------- -- ----------------------------------------- -------------------------------- ----------- - ------ ------------------- --------------------------------- ----------------- FINAL INSPECTION BY:-/ - - --- --- --- ----- --- ------ Date--4:77/ - ----- ---- --- ----------------- ------------------------------------- SAOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxellon Ave 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca.. California Tracy,California F.P.00.