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1Permit No. ,...�!_y�.��:�.,�•, APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) v��( 7 Date Issued • ----------------- 4 This Permit zExeires 1 Year From Date Issued` Application is hereby made to the San Joaquin Loca ea f E �'rict far;kor, :},o construct and install the work herein described This application is made in compliance with County Ordinance No 549. " ' ` _ . . ...�•. -�' .�` ti r mpg 'JOB ADDRESS AND OCATION-.-__-- -- 4 Owners Name-------- s ' --------- '------- .Address------- ----..._-.�-� � .'.�..` Phone C� _��. r., ----- Contractor s Name_--- ' " l Installation will serve: , Residence par+ment House [: Commercial ❑ Trailer Court El 'Motel ❑ Other,❑ tet} Number of Irvin units: _ -_ Number of bedr _ Nu • baths - -_ L ooms mberof, ot size ----------- 9f t �.• +� _ Water Supply: 'Public system.❑ Community system.,❑iPrivate epth to Water Table ft. �� ' -'Character-of.soil.-to a-depth of 1.3 feet: Sand ❑ Gravel ❑) Sandy Loamn Clay Loam ❑ Clay ❑,, Adobe Hardpan 0 ' Previous Application Made: Yest❑ No R---New Construction: Yes Rj-'No ❑ t'FHA/VA: Yes ❑ ----No { TYPE OF INSTALLATION AND SPECIFICATIONS: - } , F1,; a (No septic tank or cesspool permitted if public sewr-•is available:vvrthin 200 feet.} °, � ',-r Distance'from nearest welL------_ -._D"stance from foundation_ Zl- Materiah-----t-. ------ Septic T ! / •, No. of compartments.......P---•-----.----Size-_.4 ----------Liquld"depth--- -----Capacity.w�d - Arr�- 4 ` Y Disposal` 'old: Distance from nearest well-SZ_---. --Distance from foundafion�/��__--- .Distance to nearest lot line.----__-�.._ t + Number of lines------- GLength of each-line = d ,5x`.57..' .W'idth rot trench_=-: -------- ----- TYPe of filter material-S% epth"of filter`'ma#er al_l "" _ —Total length-------- •--------- --------. 1, r , . Seepa it: ; Distance to nearest well y __fiDistante om f ndation__/1--------.Distane to nearest lot line __ `— ._ . c Number of pits:'----- ----- --Lining material-- -size: Diameter--.,3�1------------- Depth___,�7 ..-__ -- ' Cesspool: F' Distance from nearest well.__----- Distance from foundation-------------------.Lining material--.,.------_--.--------._.-_-__--_--- S ❑: Size: Diameter----------- ------->--------- p Distance from•nearest building g--- -----------:- --------------- --- Depth --== � - - ' _ Liquid Capacity 9 � _ __ gals. ----- Privy-L:_ ,.•,____. - D tarice from anearest'well-----•-!- -- -•-------------- ry_ s = - -Distance to nearest lot line----- ---- ----- ---------------- •-------------------------x--- ---- ----------------------------- Remode4ing ad/or repairing describe] - r - -- T' ------------------------------------------------------------------ - - = -------------------------- --- ----------- = = I hereby Wy,that I e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a la a ru s and..r uI tions.of the.,San Joaquin LocA Health District. = f caner Contractor} I f - ----- -- -- -- ---- ---- - and/or E (Signed) - T s and (Title)- - -- sY= = ' (Plot plan,showing size of lot, location of system in relation to wells, buil gs, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY .. [)/ATE.= APPLICATION ACCEPTED BY_-_ -- --- --------------- - ---------- r, REVIEWED BY-- ----- -----1:------ ------ ------ ---- ------- -----'- ,---- -- --- --------- •. � DA ----- TE--:..- ' BUILDING PERMIT ISSUED------------- -- ----- ------------------•---------- - ----- ------- -------- DATE--; ----- ----- I ---- ------------------------------------------- -------- Alterations and/or recommendations:---.----_ -- =- _ ------ --------------- -----I ------------- h a-' -------------------------------- ------------ ----•--- ------------- ------------- , r•. — ------------ ---------------------------------•------- ............... ..................... r " R D -------------------------- BY - --- --- . =FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT y: ` - - 132 S camora Street .- 014 North "C" Street l30 South American Street 300 West Oak Street Y s Lodi, California Manteca; California Tracy, California F. Stockton, California :�� 1,4—2nn Reviseda-'59 F.P.Co: i ;f 4i•-