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n ) Permit No. .L1-•J--��- 4APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued -- �-•%� A San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the a with County Ordinance No. 549 This application is made 1n compliance ------- ---------•--•--•------- - • P Q 24 8_ _ --------- J08 ADDRESS AND.LO AT10N--------�---- � Phone _- ----- ------------- __-- -�----•--'---- - --------------------------------------------- Owner's Name- ----------- � -------------------------------------------•--- ----- • - ---•-�------ =•---•------ Phone 4 r� Address.__ ----------- •--•- f ---------•- -- ---------------------- --------•- Contractor's Name__________________ ----------------- Trailer Court ❑ Motel Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ / 5, /oK O _-_-- Number of baths _�(_--- Lot size ----------------- Number of living units: /_--_ Number of bedrooms �ivate Depth to Water Table '36s�ft. Er—q— system ❑ ❑ P Water Supply: Public system L1 1 Y Y Adobe[Hardpan ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Character of soil to a depth of 3 fee#: Sand ❑New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ❑ Previous Application Made: Yes ❑I No 0�TYPE OF INSTALLATION AND SPCIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well_________________Distance from foundatioqui-- depth__Material_.-- Capacity_._______. __--___ p} ank: Size -__ - - No. of comparfrnents----------------- - -- Dis#ante from nearest well-------- ----- -Distance of from each line foundation---------------- _:Width of french tance est lot line-- -- --------- isp a1'Meld: ------------Length Number of. lines______________________ � Type of filter material--------------------------Depth of filter material-----------------------// Total lengt --------------------------------------- Type .-------------• --------- ----------•---• Seepage it: Distance to nearest well - Distance om,fo cation---!__U/--•__.Distarce to nearest lot line---�y _Linin material___ Size: Diameter_ ��'�' Depth- NORO" umber of pits-_ - ------- g Distance from nearest well________--------Distance from foundation-------------- material__._____.__------------ -gals. Cesspool: -------Liquid Capacity------------ Size: Diameter1---- ------ --=-- ----- ----- ------Depth----------------------------------------------------- Size: _. ----- ------------------------ ----- -- ❑ ; ------Distance from nearest building-- --------------------------------------- Privy' ------------------------- ---- PrivDistance from'�nearest well--- -----"-=---------------- -------------------------------------------------------- y: ---- ❑ Distance to, nearest lot line___________________ r + I 1 _ -----•--•------ �.r� ;e � scribe}:-- - �el� -- - - ---------------• N Rem deli nd or re airing ---------------------------------------- ---------------- -Ti ---------•----------------- ---- -------- done I hereby certify that I have prepared this application f the San Joaquin Local rkHealltheDis#r District accordance with San Joaquin County ordinance , wi fe laws, and rules and regulations o (Owner arid/or Contract ----------------------------------- ------- ---------------------- 4:A-� - (Ti#le) ------------------------------ ---------------- ------ --- 4-4 1------------------------------- BY:------------------------- 4-?A_ (Plot plan, Showing size of lot, location of system in erse side). lation to wells, buildings, etc., can be placed on rev . FOR DEPARTMENT USE ONLY -------------------- DATE_---------------------------•- ------------------------ APPLICATION ACCEPTED BY_ DATE----14------------------------------ ---- ----- ----- -------•----------- REVIEWED BY---- -------------------- --------------- ---- --------------- ----- - -- --- --- ------ DATE..----•-�:------------------------- - BUILDINGPERMIT I�SUED--------------- -------------------- ------- -------------------------------------------------------------------------- -------- -- -- ------•------ Alterations and/or recommendations:_______-__.___-- --•-------------------- ----------- ----------•--- -- ------•--•----- ---------------------• - ----------- ----------------------------- Date------- --------------------- ------- F1NAL INSPECTION BY:. SAN :. SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 300 West Oak Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California ES-9--2M , Revised 1.57 F.P,CO-