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`. N Permi o. ._ -- APPLICATION FOR SANITATION PERMIT 41( (Complete in Duplicate] Date Issued ._.__- 5/ nd install the work herein described. n Joa uin Local Health District for a permit to construct a A, plication is hereby made to the 5a q ---- lis application is made in compliance with County Ordinance No. 549. t(� - JOB ADDRESS AND LO AT10N____ �__.¢ -----' Phone ------- Owner's Name.-------- '� -------- -------•-------- ---- - • R. -.� - Address ��Xd—----- --- -- o " Phone _ ____ •-- ---- ""� Trailer Court ❑ Motel ❑ Other Contractor's Name_____.. •-- -•� Apartment House ❑ Commercial"❑ .. r ------------- Installa+ion will serve: Residence p baths �Lot size " -- - - _ Number of living units: .---- Number of bedrooms _3 Number f }h to Water Table deft. Community system ❑ Private, p Adoba " Hardpan ❑ El Water Supply: Public system ❑ ❑ Cla Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Y No❑ New Construction: Yes X No ❑ Previous Application Made: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer stanceafromefountda ions feet-- Material-_-_"---------- -------- ---- "' Septic ank: Distance from nearest well-----------------D Liquid depth---------------- ---------Capac`ty-------------- No. of compartments-------------------------- Size-----•-------------------- q each line-----------------------------Width of trench-_------------------------------- Disposal e Id. Distance from nearest well_ ...Distance from foundation------------------.-Distance to nearest lot me.._._.___."--""-- Number o�i lines--------------'--- ---------------Length o Total length----•--------•----•-----------------F----- Type of filter material___ __,__._-__-Depth of filter material----- " l Distance to nearest lot line__ --- r - .- _- 1. See age Size: Diameter.-- -'0 � Depth.------a�""-------------- Pit: Distance to nearest welL._._��--_.___Distance from undation__- rr -___Linin materia --------- Number of pits-------l------ - g . Liquid Capacity--"- -----gals. Cesspool: Distance from nearest wel-----------------Distance from foundation--------------------Lining materia------------------------------------- OR ------------- -'-------'--'-- - f ' � ❑ Size: Diameter--------------------------- ------'--- Depth ---- ------ --------- - ---------.-""_"--"_"--Distance from nearest building------------------------------------------ Distance ----------- -- ----'------- '- J �--- DlStanCE from nearest well----------------- .. ....-._-__--__""-- Privy: - --------------- ------ -'---- ---- - ❑ Distance to nearest lot line----------------------------------------------- _- _---- ----- ---- ---------------------- : Remodeling and/or repairing descn e :__-- 4 ------- -- --------------7__-- ----------------------------------- ----- p�Y '' ---- ----------- ------------------•------------- ---- - - ------------- ----- 1. I hereby ce ify that.l have prepared this applicati San Joaquin nd that hlrocalkHealltheDistr ctdone n accordance with San Joaquin County ordinances, State laws, and rules and regula+ions of (Owner and/or Contractor) .•`-------- ------ Si ned - . ( 9 ) -(Title By:----------------------------------•---- --�-•_ s - --------------- Plot tan, showing size of lot, to }ion of system in relation to wells, buildings, etc., can be p ed an ire side). ( r l� R DEPARTMENT USE ONLY DATE------. ----- ------------- DATE APPLICATION ACCEPTED BY-------------- - ----------------------------- ------•------------ `} REVIEWED By-------------- - -------------- "---------- DAT �/--- --- - BUfLDING PERMIT-ISSUED----------•------ _ - Al+er +ions and/or recomme a+ions:._.. ._. -__ - -- - - `a" ! --------- ---- �[... FINAL ate-------- r"-- — --------------FINAL INSPECTION BY•------ SAN JOAQUIN LOCAL HE LTH DISTRICT Sia North "C" Street 30D West Oak Street 132 Sycamore Street 130 South American Street Man+eca, California Tracy, California Stockton, California Lodi, California ES-4=2M I0-52 Revised W-2400 -- -