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Permit No. XN APPLICATION FOR SANITATION PERMIT (complete in Duplicate) Date Issued the work heieir�-desc?ibecl. San Joaquin Local Health District for a permit to construct and installa Applica+ion is hereby made to the Sa with County Ordinance No. 549. This application is made in compliance 101 ADDRESS AND gLCATION------------- -- 3 5e AL, ---- Flh one_,�/V_ - ---------- P ------ - - - --------------- -------------------------- -------- A, --------------- -------------------- Owner's Name-------- -------- •-------------- -------------- Address------ ---------------------------......-------------- Other [I -- -------- -------- Contractor's Name----------------------------Re si dence 0 Apartment House [3 Commercial [] Trailer Court 0 Motel ------------- Installation will serve. rooms J---- Number of baths I--- Lot size 7�/__XZO-!�------------- Number of living units: __/---- Number of bed De Supply; Public system th t o Water Tabl6 '�_ ft. El tem TrCommunity system Private 0 p Water Sandy Loam 0 Clay Loam[I Clay [] Adobe B"Hardpan C1 Character of soil to a depth of 3 feef. t Sand [] Gravel n Previous Application Made: Yes 01 No g?" New Construction: Yes F-1 No TYPE OF INSTALLATION AND SPECIFICATIONS: 'sewer is available within 200 feet.) permitted if public (No septic tank or cesspool I M ferial _LO"O Distance from foundation__ -------- W f well'�------------- 74---------------Capacity__-?�V�__ed, I Septic T k: Distance from nearest Liquid depth- Q.. Of compartments- ------------- Size_.-S�� -4------ - . / ----------------- ounclatrin .-/Jd----------Distance to nearest lot line a t welf.)�.,Lp. Distance from f Width of trench ;2 ............ ------ I Disposal Field: Distance from near -----Length of each line-_i - ---------- ------- K ------- '_Ao----------------------- Number of line k _Oiq --Depth of filter material---/j __.Tof.al length I material . _? - __ - Type of filter-far ma ------- - --- e'f from foundation-------------------Distance to nearest lot lfine..______._-.__.. Distance to nearest.well----------------------Distanc Depfh--------------------------------- Seepage Pit: Number of pits----- -- ----- ... ...Lin�ng material---------- ------------Size: D�ameter----------------------- -------------------------- from foundation--------------------Lining material------------ Distance from nearest well-----------------Distance ---------Liquid Capacity_---------------------------gals. oV. Cesspool: Size: Diameter-------------------- - ------'Depth-- ------------------------------ ------- est building---------Distance from near , IPrivy: Distance from nearest well----------- ---------------- -------------,-1-_._-------:-------w-------------------------------------------------------------------- Distance to nearest lot line_----------------- ❑ Remodeling and/or repairing (d --------------------- eslcribe):-- --------------------------------------•- ---------- ---------------------------------------- - --------------------- ---------------------------------------------------------------- --- ------------------------ I--------- ----------------------------------------------- ------ ---_---------------------------------------------------------------- ---------- ------------------------------------------------------------ .......I--------------------------I------- ------------ ------------------------I--------------------------------------- -------------------------------- ------------------------------------------------------------------------- Joaquin County ------------------------------------------------------ ------------------------ A that the work will be done in accordance with San Joaqi y I hereby cert that I have prepared this application am d have * lotions of the San Joaquin Local Health District. ces Sta Teaw and rules- and�r�etivn ordinances, Contractor} (Owner and/or C a ......... . . - (Signe ----- ------------------------ ,- -a- ` ... . .. .... ----------------------(title] -------------------------------- --------- ..... .......... --- ------------------- - --- - d)----- -------- - I I-place oh side}. --------- A reverse e By----------------------------------7-------- system Its, buildings, etc., can be place 0 m in relation to ells,lot, location 7 (plot plan, showing size of lot, I FOR DEPARTMENT USE ONLY DATE------ --------- -------- -------------------------- APPLICATIONACCEPTED BY-----------------------------------�- ---------- ------------ DATE----------- ---------------------------------•------------ REVIEWED BY-------- =------------------ ------ ----- - - , --------------- DATE......I-----_--------- 1j---------- --------- ------------------------------------ - --------- BUILDING PERMIT ISSUED-------------------------2-t--- - ' - _- - - s ------- ----------- - ----- 4�-_ Alterations and/or recommendations --- ------------------------------------------------------------------- -------I------------- ------------I----------------------------- --------------- -----------•--•--------------------...... ------------_--------------- ----------- --------------I-------------------------------------------------------------------- ---------- ------------------------------------- -------------------- ------------------------------------------------------------------------ -------------------------------------------------------- ---------------- -------- ------ -------------------------------------------------- ------------------------------------------ ...... ---------------------------------------- .... --------------------------------------- ---------------------- -------------------------------------------- ------------------------ --- ----------- -------- --- - ------------------------------------- Date-.--- FINAL IN-z)PECTION BY:_; ----------------•------ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 N'tirih "C" Street 132 Sycamore Street 130 South American Street 300 West Oak Street Manteca, California Stockton, California Tracy, California i Lodi, California 145446 A_(_WOD-