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FOR oFFICE USE: . • `f` Permit No. .../. oto APPLICATION FOR SANITATION PERMIT ----------- -- -------- (Complete in Duplicate) Date Issued -- ---- ----- -_ This Permit Expires 1 Year From Date Issued 4, -- ('11, . Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. This application is made in compliance with County Ordinance No. 549. s � K 4W .741 %- ---------------------- JOB ---- ----••--:--------- JOB ADDRESS AND L TIO _.�- ----- - �- -- - --- -�� ---- _ _ Phone------------------------------------ Owner s Name_____________ _ __ - •••----- -- - -- I ---- - --- Address-----•--------- - • -- • _j'•-- t ----•------------------------ •------- Phone=------------------------------ Contractor's Nama________ I_ _ __ t - -' Apartment Nouse ❑ Commercial ❑ Trailer Court ❑ Motel. ❑ Other ❑; Installation will serve Residence ❑ p i Number of living units: ----/-- Number of bedrooms -� Number of baths '3--. Lot size _._ s - •---- •---------------------•- Water Supply: Public system ❑ Community system ❑ Private Depth to Wafter Table t�r0- Character of soil #o a depth of 3 feet: Sand ❑ Gravel ❑ Sa Loam ❑ Clay Loam ❑ Clay ❑ 3 Adobe �ardpan ❑ VA: Yes I -- New Construction: Yes ��/No ❑ FHA/Previous Application Made: {lyes,date----------- ----- ) No � TYPE OF INSTALLATION AND SPECIFICATIONS- ' 41 ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �: I G < ► p _ Tt Mat naL=�- -------- - Septic T Distance from nearest well'!_..'.--Distance from foundation__ _____ �� Liquid depth- } Capacity. No. of compartment-- - ---------A - ' ) Dispose leld: _Distance from nearest w {I ._.Distance from foundati n'. 6 Distance to: nearest lot line_- _---- Z' �Widfh of trench.----- l.-___._.----- - Number of lines------- f--- -- -----Length of each line_ _ .___..�_�--. f J�..De th of filter material_ `` �1-----.Total length-.__��--------------�----- Type of filter material___/ �.1 p f� i �. Distance m foundation--_ __ __ _..Distance to'.nearest of Ime..'S/----- Seepa Pit: Distance to neare t well.._ -- - Size: Diameter _v.----.Depth_ ----- --•--- -- l 'Number of pits-rte-_---------Lining maternal_ --..-_- -'�Unin material ,` 9 Cesspool,; Distance from nearest well-____,_____. Distance from fou.nclation_________________ _ •� -- -De th_".`'-= ` '1_J�----------------Liquid Capacity-- ----------------- ----ga s. ❑ Size: Diameter------------------- r}`.T__ p _ --Distance from nearest buildin - ------------------ Prly Distance from„nearest�we ____----------------------- _ y: r---- '- - ❑ Distance Ito nearesi"lot.,line------------- --------- �� Remodeling and/or repairing ------------------------------------------ (describe):-------- ,: I ------__.--- '�' }- ------------------W ---} ' l I f done-in , I hereby certify that I hiave parepare uAis ap lli ati San Joha th workal Heall h D s r tacc�orrdanc�with San Joaquin County ordinances. State and ryul 3a --------------eeo 0-towner and/or Contractor) ----- ------ ----------- - ---------- ----------- ------------------------------- i e ---- sy:_ ---------------------- -- (Plot plan, showing siz of ot, location of system in relation o wefts, buildings, etc., can be placreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED "----"-" --------- ----- ----------------------------------- DATE---- 1(a -------------------------------- ---- DATE-----------------------------------------•--------------- REVIEWEDER ----------------------�'--i----------------------�#----- ---------------' ------` ---- �4.R--------------------: -------------------------------- - - - -------------------------- BUILDING PERMIT ISSUED--------� ----------- --------- ------------------- ------------------- TE• 1 " Alterations and/or recommendations:-.._i..'___�P.:_{p ---------� -------1 k�`� �`` �`�•- --- - --------------------------- -- FINAL INSPECTION BY:---__...C..*.._� Date----- -�--i-1-0. k SAN JOAQUIN LOCAL HEALTH DISTRICT `' 205 West 9th Street 300 West Oak Street , :.124 Sycamore Street 1601 E.Hazelton Ave, y u+ --4 �. _ ...� Troty,California Lodi,California Manteca,California Slotkto'n Cafif6'rofa'.�"��-.w, • F.MCC.