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APPLICATION FOR SANITATION. PERMIT Permit No. /- .lo.G " (Complete in Duplicate} This Permit Ex ires 1 Year From Date Issued Date Issued Application 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 with County Ordin nce No. 549. bed. JOB ADDRESS AND LOCATIO ` LOCATIONj el �. ------ - -- - z Owner's Name--------- ------•--------- - ------ ----•--------------•---- •----��---�- "�--��`� --- Address------------------- ---- one__ 8 Ph --------- ----- -- ----- . -- - )----•--- --•-- - Contractor's Name ----------------- -------------- --- Installation will serve: Residence - ----- Phone.__._______-______ ❑ Apartment House ❑ Commercial Number of living units: J_____ Number of bedrooms _ E] Trail Court ❑ Motel L] Oth r ❑ ___Mote ............. Number of baths _ A-l=ot size Water Supply: Public system .______ Y y E] Communit Community sus ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand 00 Gravel ❑ Sandy Loam ❑ Clay Loam Cla ❑ y ❑ Adobe r Previous Application Made: Yes ❑ No ❑ Hardpan [] I TYPE OF INSTALLATION AND SPECIFICATIONS: Construction: Yesjo ❑ FHA/VA: Yes ❑ No ❑ I �n (No-sept,c.tank or cesspool permitted if public sewer is available within 200 feet.) 11 Septic Tank: Distance from nearest well---5—1 Distance from foundation-/10-----_ No. of compartments Mater'al_- p ----- -------------------------------- ---_------ �----Size_�_�------- Disposal Field: Distance from nearest well--s& Liquid depth- ----- Distance from founddtion._�_J__---_- _ Distance e to nearest lot Ii - �...�., Number of lines------ _ r...• s.� ��-----•-- 1 ength of each line___----4� -�� Type of filter material____ t- S.Widthi df trencfi._- depth of filter material___-,/ i' r SeepagePit: ----Total 'length---11,7-Q_---------------------- ---------------------- Distance to nearest well from foundation_____-.__ Distance to nearest lot line__.--___--___.__ ❑ -------- Number of pits«_ --- --- ---Lining material-- --- --- ---- Size: Diameter------------------------Depth Ces's ool: R p Distance from nearest well___--- ��-•-Distance from foundation--------------------Lining material-___.___-_. - ❑ Size: Diameter------------------ -- 1 -----------------Depth-------- ---- --------------- t --------- ------ Liquid Capacity Priv _.gals. Y• ` . Disfiance from nearest well-------------- 1' - •9 i -----------------------------------Distance from nearest building ❑ Distance to nearest lot line. _________ .- g ------------------ .. �.. --------------------- Remodeling and/or repairing (describe]:___.___- --•------ -------------------------------------------- - ---------------•----------- --------------------------------------------- --•----------------- -----------------------------------------•---------------------------------------------------------- -------------------------------------------------- ---------•------- -------------------------------- ordinances,I hereby certify WBf I have prepared this application and that the work will be done -- accordance with San Joaquin County State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- -- --- --------- -- � --- - --- -------------------------------------------------------- ---------------- ------- sY� ?.- �- (Owner and/or Contract 0 ort . (Plot plan, showing siieof lot, lova+ion of system in,tela#ion to wells, buildings, etc., canbeplaced an reverse side). �. _ F ART f ENT US NLY APPLICATION ACCEPTED BY---- ---- -- ---- ^� / REVIEWED BY------------ -------- ------ —--------------------- DATE - " -------------------- ---------------------------------------------------------- BUILDING PERMIT ISSUED RATE ---------------- Alterations and/or recommenda+ions:-------------- — DATE------------------ ------------------------------------------- e -------------------------- - ------•--- ------F•-----------•- FINAL INSPECTION BY_____________ ----------------------- Date---------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Ameritan Stree+ . �' 300 West Oak Straet4 ore:St Stockton, California 132 Sycamreet r� 014 North "C" Lodi, California _ Straet FS-9—ph} Revised 8-'S9 F.P.Co. Manteca, California ; Tracy, California 1