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FOR OFFICE USE: -=----- ---!.3 p- ------ - - • �- ------ ---- ------ --- --------- - --- APPLICATION FOR: SANITATION PERMIT_ Permit No. Y This-Permit Expires 1 ' _ -------------------- ------------- (Complete'-in Duplicate) --. _..- `-.'- ----- - - ---- --- ----- ---- --- � `IYear 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 Ordinance No. 549. JOB ADDRESS AND OCATION______ �ir� G G/ Owner's Name. � k I ------------- ------- --------- ---- Phone__ /..� ----------------•--°=--------- ----- --- - •------ ---- Address -G� �P ,��: ----------------• • I Contractor's Name------------ ----I--------- ------ ` Phone.._._ Installation will will serve: Residence Apartment House ❑ CI mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: e. Number of bedrooms ___f_ Number of baths _/__-- Lot'size ....v //vv_-----__----- Water Supply: Public system ❑ Community system ❑ t Private ®-5e—pth to Water Table �ft Character of soil to a depth of 3 fee t• Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_"..._-__-------- ) No'[] � New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is a4ailable within 200 feet.) Septic T Distance from nearest wel_____. -_ --Distance from foundation j --/�--- ----`.Material._.- .��f�2'-- -_.l`7•v� No. of compartments= -Size_ -`1" l I . _ .. /�.: Liquid depth ��/ --- - Capacity----- > ------- Dispasaf field: D•rstance from nea4st well.."""i----_Distance from foundation.� -- 0-- --,--Distance to nearest lot Number of fines--. ` .___ ---Length of each line _ ----- _ _ . _ .__..Width of french....s ___ ______ _________ Type of filler-material....ko-A -_Depth oif filter material- -f( ��_ -_-Total length 9 - ---------------------- Seepage Pit.:�� Distance to nearest well.___-----------------Distance from foundation-----_-_--___-_-.-Distance to nearest lot line----------------- ❑ Number of pits "= --_•Lining material_fl ------. ... Size: Diameter-----------------------Depth-. - Cesspool: 2 Distance from nearest well _______________ Distance from foundation._____.......... ..Lining material _..---_.---------------------------- 0 Size: Diameter- .- -------- - '------ ----- Depth---:';---- ----- -- ------ -_---:----------- --..Liquid.-Capaci#Y`--•---_-_'- Privy: Distance from nearest wo...................... Distance from nearest building ❑ Distance to nearest lot line_________________.........._:�.__ - Remodelin and/or repairing (describe):-------- .- �Gr/ � �-------�— -�—_----------+ .I --------------- f ---------------------------------------- --- ------------------------ ___..___..__._...__ -- _----.--------------------_-------------------------------------____�_.__. -----------------------..--------------------------.___-_---____------____.__--....--.._-------__-__-.____._._--_------._.__.-.-. __ . I hereby certify that I have prepared this application and that the work will be done in accar,'dance with San Joaquin County- _ - ordinances, State law rules and reg a ns f the San Joaquin Local Health District. (Signed)- ---- ------- -- ------ - ---- _(Owner and/or Contractor) _ - -------•- ----------------- ----- ------(Ow d/ BY:----- ---t------- ---- - - 4 -- - Title .L .c _ n or 0 (Plot plan, showing size of lot, to n of system in re anon to wells, buildings, etc., can be placed on reverse side). , J. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ../----- L- ---- ------------------'------------------------ -------------- DATE_.... S ---------------------- VIEWED BY---------------------- -- --------------- --- ---------------------------------------':-----------------------------•------._ DATE------ - ------------ -----•------------•------- ----- UILDING PERMIT ISSUED-------- --------- ----------------------------------------- -`' --------- DATE----- ------------------------ Alterations and/or recommendations:___.-_-.____._. _.' i - I ------------------------- - --------------------- ---------------------------- - - ----------- -------•-- -------------- ----------------- ----------------------------------------------------- --- --------- --------------- - - ------ ------------ ------ FINAL INSPECTION BY:....-lN- k._.I-kv- _..-k. .-- _-- Date S l2 Z C� I--- .-------------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT } 1601 E.Na:eltan Ave. 300 West Oak Street � � � `l � 1�24`3ytamore`Stree} � � � 205 West 9th Street: 5lockron,Califamin Lodi. California '� - Mante[a,&Iif\is '�` E.H.9 2M 1.67 Vunguard Press I Tracy,California Y° i'r :..,. ;I