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ot APPLICATION FOR SANITATION PERMIT Permit No. 1complefe in Duplicate) Date issued Joaquin Local Health District for a permit to construct and install the work herein described. -�reb made to the San �Thpsapplicationlication Ohe ��\ a with County Ordino549.is made in compliance i I ------------------- ------------------------------------ -------------------- LAAX,471-/ ---------- ---------------- -------------------- JOB ADDRESS LOCATION_._ - ----- ------- ------ Phone------ - Owner's Name---_---.------- ------•-I -------------I---------------------------------------------------- 03 1 %5 - --------- ---------- Address.----4 �----c - ---- - ----------- --------------- ----- - Contractor's Name____ -------------------- Ap-a-rt-ment-_House [I Commercial C] Trailer Court [I Motpj El Other [I on will serve: Residence ------- ---I------------------ Installati ---- Lot size -1:57-0......A� - Number of living units' umber of bedrooms _-_I___ Number of baths _Xommunity system 11 -Private [] Depth to Water Table --------- ft. Water Supply: Public system be 15/Hardpan 0 Gravel M Sandy Loam Clay Loam [I Clay E] Ado depth of 3 feet: Sand �p Character of soil to a 1P Construction: Yes Mr No El Previous Application Made: Yes F1 No [ New TYPE OF INSTALLATION AND SPECIFICATIONS: f available within 200 feet.) I iE Rublic Fewer is �tion----1_01j" 0 a) - - --------- (No septic tank or cesspool permitted i Distance from nearest well- froariffoupiJi ----- - - ------ YC -Capacity---- . ...... ---Liquid depth------------------ ------ -- - Septic No. of compart! -----size_ Distance to nearest lot merits---- ------ --- 4- Distance from foundation- 3-1------- - ------------- DisposVFeld: Distance from nearest w 11 h- - 1.0. ---Width of fre 11. Length of each line___--__ ----(0- -----F -----------0length---------- -- ------------------- Number of lines___________ 9epth of filter material- -----Total length-'-'---- ----0 Type of filter materis*f M70- ce from foundation----- -----------Distance to nearest lot line_________________ Seepage Pit: Distance to nearest well ----------------Distan.......................Size: Diameter--------,--------------Depth--------------------------------- El Number of pits----------------------Lining material Cesspool Distance from 'nearest well-----------------Distance from foundat;on------------------- Lining material-------------------------------------- Size: Diameter-------------------------- Depf h-----------------------------------------------------Liquid Capacity---------------I------ ❑ Distance from nearest building------------------------------------------ Privy: Distance from 'nearest well_____--__--❑ ----------------- Distance to nearest lot line------------------------------------------------ 'crib :----- ----- 1) A - - --------- -------------------------------------------------------- ------------------------ R*m a '1.1,-retaillrring ------------------------- ---------------- -- -------------------------- --A----------------------- ---- ---- ---------- -- ------------------------------------------------------ at --------------------------------- ------------------------ ---- ------------------------------------------ ------------------------- -------------------------------- v V -------------------------------------------I----------------- ----------_ ----------------------------------------------------------------------•- ----- --------------------------------------- -------- ---------- ----- - I hereby certify that I have - prepared this application and that the work will be done in accordance with San Jo.aquin County ordinances, State laws, and rule,�&46rnc�regulatioris. of the San Joaquin Local Health District. ----------(Owner and/or Contractor) -- ------------------ __-------_-________(Owner -------- --- - -------------- By:------------------- - (Signe4j_ 4111�_ _ �----------------;------------ -------------------------------------------------------------------------------(Title)-----------------------reverse-e__se -e-)---------------------------- By:-------------------------- --- k -- in relation to wells, buildings, etc., can be placed on rev -(Plot plan, showing erxe of lot, location system FOR DEPARTMENT USE ONLY BY ------------ -------------------------- APPLICATION ACCEPTED I --- DATE-- --------------------------------------------- ---- ------------------------------------------------ ----?;;� U% REVIEWEDBY---------------------------------- ------------------------------------ -------------------- -------------------- DATE------------V--------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------- ---------------------------- recommendations:-------- --------------------------ffp_)).5�3--------------- ---------- ---------- Alterations and/orI ---------------------------- --------------------------------------- -------------- ---------------------------------------- --------------------------- -------- ------------------------------------------------------------------------------------------- ----------------- ------ ------------------- --------------------------------------------------------------------------------- ---------------- ---------------------------------------------------- ------------------------------------- - Date--------- ---- ---------------------------------------------- FINAL INSPECTION BY:----V----------- ------ ------ -------- --------- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 130 South American Street 30 132 Sycamore Street D West Oak Street Tracy, California Lodi, California Manteca, California stockfon, California ES-9-2m s-51 Revised W-2100