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APPLICATION .FOR SANITATION PERMIT Permit No.ZU.�------ (Complete in Duplicate) Date Issued--- 1 7Zj---� Aplica+ion 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 corripliance with County Ordinance No. 549. P WAV&A - JOB ADDRESS ALD.LOCATION--- 9:4,109; 4--- ------ -----------7- A"Z jOr- r . in ---- 404K.-C-40----C3-4-------------- Phone---!r7--------------------- Owner's No -- ---- Add ss----------------- r! --------------------------------------------------------------------------------*------------------------- Contractor's Name--------------------------- ----rili -157, ---------------------------------------------------- Phone Installation will serve: 1 Res iclence-j-dt. Apartment House,[] Commercial E] =Court E] Motel E] Other ❑ Wmber`of living units: I-----NAber of bedrooms,3--- Number of baths I--- Lof"size ___---4#19velm-------------- ----------- Water Supply: f [I Private'emi'E] m6o �nunify sys -em Privafej<'13epth to'Water Table 0/tOff. syst . � — I Character of soil to a depth of 3 feet: Sand D Gravel ❑ Sandy Loam El Clay Loam E] Clay ❑ Adobe_Z Hardpan 0 Previous Application Made. Yes ❑ No X New Construction: Yes)( No El TYPE OF INSTALLATION AND SPECIFICATIONS- j (No septic-tank or cesspool-permitted if public sewer is available within 200 feet.) I Septic-Tank: Distance fr; om nearest W from Material--- 105-10-4ik.. . . .......... 7 .No, of compartments__ ---- - ------".------Size dep{h--".""------------Capacity----------------------- xtall ��_!t_Liquid Di I Field: Distance from neareit wejj.0foundation_ . ..... from --7 ._.__._.Distance to nearest lot line----1- so N r umber-of�lines------nearest ........Length of each line-,ez- ------Width of trench--A-*.,,---------------- (S f I Type�e oT' filter material-Al-lift---------Depth of filter !atu4rial.....If 41V�-J-----Total length--ff40" IN i yp ------------------------------ nce fro oundafion- Seepage Pit: Distance fo nearest well-1004----------Dista' f7�rDistance to nearest lot line-----4 Number of'pifs---- ---------------Lining material-- S;ze-. Diamefe`r-A-3,'"---- ----Depth-r....._____-I--------- Cesspool: Distance from nearest well__-_______`___'Distance from founclaflon--------44-----Lining material________________________________ ❑ e Depf h------------------------------------------------{ --Li quid'Capacify-------------:--------------gals. iz': Diameter------------------------ - --- Privy:t I Distance from nearest'%;vell---- - -----------------------------z--------------Distance from nearest building------------------------------------------ Disfancb to 6edrest.Iot'Iin6..-1-- -------------- ------------------------------------ --- --------------------------------------- ------- Remodeiingand/or repairing (describe)---------------------------------- -------------------------------------- ------------------------------------------------------------------------ ---- --------- -----------------------------------------------I----------------------------------------------------------- -------------------------------------- -------------- ------------------------- --------------------------------- -----------:--------------.............I--------- ------------------ ---------------------------------------------I----------------------------------- -------I---------- --------------------------------------------------------------I--------------------------------------------- --------------------------------------------------------------------------------------------------------------- Ij1here6y c ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ify "at I a ordinances, at laws;sac I r�andjr'e� ulations of the San Joaquin Local Health District. ------------------ -ontractor ------------------------ ------------------- -77��c B, ............ (Signed)- itle No ----------------- ------------------------------ ------ ---------- ------ -----(T (Plot plan, showing size'of lot, location 6, sysfiem re afion-to well buildings, etc., can be aced on -01 reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - -- --------------------- -------------------------------------------------------- DATI�-5:--. 4 -------------------------------------------------- REVIEWED BY-------------!------------ ----------:-------------- - - ----- DATE-----��--------------------------------------------------- ' - ---- ------------------------------i- - ----I--------------------- --I W\ I BUILDINGPERMIT ISSUED--------=-----------------=-------------------- -------------------------------------------------- DATE--------- --------------1-•--•--- -•- Alter;fions and/or recommendations:--i.........-------------------------=---=---------------- I---------------------------------------------- ------- ---------------- ------------------------------------------------------------........----------------------------------------------------------------- - ------------------- ---. -------- ---------------:-----------------------1�- --------------------------------------- ------------------------------------------------------------------------------------------------ ---------------------------------------- --------------- ---------------------- .........L----- --------------------------- ----------------------------------- - ------------------------------------------------- ---------- -----------L . , 7k ------------------ -------------F, - I 1 --- ----------------- ------------------------------------------------------------- ----- -------------------------------- ---- ------ ------------------------------7------- -------- z ------------- FINAL-INSPECTION BY:...... --------- ------- -------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-•2M Revised W-2100