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FDR OFFICE USE: --------- -----j APPLICATION -�O'R SANITATION PERMIT Permit No. . ---.--3 ' -------- ---------------------- -------- ------ ------ ------------------ -- (complete-in Duplicate) Date Issued �� ---- ---- - --------- This Permit Expires 1 Year From Date Issued .... -- --- - - Application is hereby made to the San JoaquiouL��+caOl�en�tnceDiNoG 549.a permit to construct and install the work herein described. ' This application is made in compliance with County �/ T JOB ADDRESS AND L AT10N--------- Phone----•------------- -----•------•---- -- --------- --- ---------------------- - Owner's Name- ------- -----(�-'r`r"��.._----------�-�---� -- ------- ---•------"------•--•• Address------------- -- --- --- ------- --- _ one. Contractor's Name.......... .... - ---- --------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ' Mot Motel ❑ Other Number of living units: -/--- Number of bedrooms __./- Number Depth baths o WateroTaible .��- -�- ft l Water Supply: Public system ❑ Community system ❑ PrivateP pp y: ❑ y ❑ Aclobe,& Hardpan ❑ Character of sail to a depth of 3 feet' Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam Cla No El Previous Application Made: l4f yes,date-------- -.:---- -- ) No New Construction: Yes "'i"" No E] FHA/VA: Yes [I TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) � Distance from #oundation_. ..4- -.----Materia! -------- ----------------- ---- - -------- Capacity F r'� �• r Septic Tank: Distance from nearest well. Size __�-- - "/�-t�--•Liquid de ----- P Y No. of compartments---------CO)- ------ . AI--------- to nearest lot line ----._Distance from foundation � . t Disposal Fie}d: Distance from nearest well_� - --. Width of trench..._ -•-- ------------" Number of lines.._.___1-------------- Length of each line-- . -----ri �- Depth of filter maters!__ 1------- ---Total length------- V------------------ Type of filter material_- - e f / Distance to nearest lot line. ------- .900 ---- See age Pit: Distance to nearest we}} �3Q"._.._.._Distance fr40-e 4om fo nd5�ieon4. eter._4.�_-._•-----. P Linin material._ t - De th * - w Number of pits..- .-/------- g ing material Cesspool: Distance from nearest well ----------Depth from foundation_----------- Liquid Capacity..--------------------------gals. ❑ Size: Diameter_ -. Distance from nearest well----- ---------- -- - -- - Distance from nearest building---------------------------------------------.-_""---.. Privy: --------------------------------------- ' ❑ Distance to nearest lot line_.-.- _--._--.__".- -_ Remodeling and/or repairing (cicscribe)------------------------------ ------ ----------------------------- -° \ --------------------- ----------------- l.'k` -- ------------------ --------- -------•-------------------------------------- -..---- ------ -----------------------------------------------------------------------r ----------------------------------------------------- ---------------------------------- ---- -.---------- - -----------------------------------------------•---------------------- --------------- wil done r I hereby certify that I haveprepared regulations application the Sand that the in workcal HealthleDistrictn accordance with San Joaquin County ordinances, State law and rule _. w e and/or Contracfior) 5i Tied - -- -- --- -- �- --- --- ------------------- (Sign'e' d) - ----- ----- ------- ---- ---�-� --- ---- V�l --Qr------ --- � Title By:--- {Plot plan, showing size o ot, location of tem in relation to wells, buildings, etc., can be placed on rev se sl e . _ FOR DEPARTMENT USE ONLIly" I APPLICATION ACCEPTED B - --_ . (- -- -------- DATE /. -- '�--------------------------- -- ---------------------- DATE REVIEWEDBY------------------------ ------ --------.! ----------- DATE------- --------------------------- ------------------------- ' BUILDING PERMIT ISSUED-------- ------- ----------- --- --------------------------------------------- --------- Alterations and/or recommendations:_-._.- -_: -� ------------------------ -------------- --------------------------------------- -- ------- "---- --------------------------------------- ---------------- ---- ------------------------ IDate A_ --- ......_ ------------------- FINAL INSPECTION BY:. - SAN JOAQUINOCAL HEALTH DISTRICT I124 Sycamore Street 20.5 West 9th Street 1601 E.Ha:+It+n Ave. 300 Weal Oak Street Stockton,California Lodi.California Manteca,California.. Tracy,California E.H.9 2M 1-67 Vanguard Press