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. .. Permit No. a APPLICATION FOR SANITATION PERMIT f 1 3 0\ s (Complete in Duplicate) Date Issued -- 17- Appliceion 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 Iwith County Ordinance No. 5 9. JOB ADDRESS ND LOCATION----_ .-_� --- --- p- ------------ -- -------- Phone. - ----� O Owner's Na ------- Address ---- ---- ------- - Phone---- , c5 Contrac or's Name...........:..... — ---- - '---------------------------------- -----------------------• -- # Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ ❑ Number of baths ---/- Lot size --,1 d ----------- -------------- Number of living units: _-- --- Number of bedrooms �. :. Water Supply: Public system ❑ Community system ❑ Private ET Depth to Water Table ft. ❑ Adob Hardpan ❑ Character of soil to a depth of 3 feet: Sand 171 Gravel F1 Sandy Loam ElClay El Clay Previous Application Made: Yes ❑ N New Construction: Ye)!kNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 eptic T rxk: Distance #rom nearest wel}-------- -"_--___-Distance from #aundation____________________Materia____.___-__._..__.__._____.____.--------------- iJo. of compartments---- ----------- -------"Size------•------------ Liquid depth-------------- -----------Capaci#y_.. Dispos Fie Distance from nearest well-----------------Distance from foundation.--___---_---"_--.-.Distance to nearest lot line__..__._.________ Length of each line Width of trench --------------------- ------------ • Number of lines------------ - it g Total length--------------------•---------- Type of filter material-_-- ---.Depth of filter material__________________� Y Distance to nearest lot line-__4,� _--_Distance f m fou ation__ -•----- t �� Seepa e Pit: Distance to nearest well_- -- Number pits--- ------------- ing material_. �-.Sixes iometer---• - ----- --._.Depth-- ------ R Distance from foundation._.._.--- -Lining material-------------;------------------ cesspool: Distancetfrom nearest well _____________ ------ — _ also `De th--------- = Liquid Capacity---------------------------- le ... :; gs N . ri Distance rom nearest weil-----...._-------------------"--------- ---------D stance from nearest building Privy: ❑ Distance i-o nearest lot line----- -�-----•- ------------ -------------- -- ----- --- , -' ----- ~ Remodeling /or r firing (describe): . - )2� - -•-- -----------------------------------•------ - = i1I71 TA��IGE---CLOZE ---THAM-- QUI ED ,r B. r� ----------------------------- ----•----------------- --------•---------- ! t I hereby certify.that l have prepared this application and that the work will be done in accordance with San Joaquin oun ordinances, Sta a laws, an ule and regulations of the San Joaquin Local Health District. I- w and/or.Contractor] Si - --- --- ---- ---- ---- s ( gned) r' (Title)-------------------- -- -- ( (Plot plan, showing size of lot, location of stem in relation to wells, buildings, et.c., can be placed an everse e. FOR DEPARTMENT USE ONLY t DATE l ----- - --------- ---------- I APPLICATION ACCEPTED BY----- DATE: --------- REVIEWED BY------------------ ------------------ ------ ---- - - DAE: BUILDING PERMIT ISSUED-------•---------=---_:------- -------------------------------------------- Alterations and/or recommendations:__° ----------------•-------- F i ------ --------------------------•----.- 01 # �� ------ ---------------- 1-- xDate_------ -------- ]-----------•---- - FINAL INSPECTION BY:------------------------ ---- - s SAN JOAQUIN LOCAL HEALTH DISTRICT # 132 Sycamore Street 014 North "C" Street 130 South American Street 300 West Oak Street Lodi, California CaliforTracy, California Stockton, nia f Manteca, California y �.� E_-�2M 1.5446 P7W90P 12-54 - - -