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FOR OFFICE USE: _ 049Y'O _ -------- -------- n Permit No. _i.2l- . ----------------------- - - 11 APPLICATION FORS'SANITATION PERMIT ----------------- (Complete in Duplicate) Date Issued --�.___ ��2- "", .-_` r This Permit Expires 1 Year From Date Issued Application is hereby made.to„the San Joaquin Local Health District for a permit to construct and install the work herer� This application is made in`compliance with County Ordinance No. 49. fr•,�6 _f JOB ADDRESS AND OCATION------------- - --- ---------•--- O _ - Owner's Name ----------- ------- Phone---------------------- -- Address----- Phone------------------------•----G .. --- Contractor's Name----- 2� Installation will serve: Residence Apartment House ElCommercial F] Trailer Court ❑ otel ❑ Other r Number of living units: ______�lNumber of bedrooms -------- Number of baths .___ _ Lot size _ ` c � - -- * Water Supply: Public system El !:Community system ❑ P"3vate93 Depth to Water Tabled ft. x 'Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand [I Gravel E] Sandy Loam lay Loam E] Clay ❑ ❑ Previous Application Made: (If,yes;date---------....------..) No I� New Construction: 'ryes 2�, No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION'AND SPECIFICATIONS: 1� m ;(No septic tank or cesspool,permitted if public sewer is available within 200 feet.) ,� t Septic Tank: Distance from [nearest well. _- Distance fro found tion__f ---"f' Materi+aJ._ D' ----- - �,_�,�y �x_ �- Liquid-depth___- -lir---Capacity'--- -u__{,�r No. of compar:'Fments_-__ ,7------------Size------ - --- ---- --- -` - J +' c'. / 4,� _:l't__.Distance to nnearest.lot li e> _l Disposal Field: Distance from nearest well- "--Distance•from foundation___ ax -- Len Length of each line-------- _- =- Widffi':of treruch -- ----------------- - �' Number of lines — .�a � 9 s , t! ' s` ` t Type of filter materia __, _ Depth of filter ma a a----.__: ----Tytotal Iength_�- �s�-=------------ r I �.. Seepage Pit: Distance to nearest well----------------------Distance from foundation---_.___ -----------------Distance to nearest lot line_.._________.:_ Number of pits------`___. -------Lining material------ --...`---__ .Size: Diameter-- ------------------Depth,,_-1 -------------------------- t ..;; ❑ , it Cesspool: Distance from,nearest well-----------------Distance from foundation___. -------------Lining ma erial-__...!-Y:__--.________---.----_---- ❑ w .. Size: Diameter------ --�---------- -- -----Depth-------------j ------------------- 4---------i�Liquid Capacity- )-----------------------gals. Privy: `, Distance from nearest well___________________________ �-�----- - Distance fWrn nearest building------------------- ❑ Distance to nearest lot line-e-..-------- -------------------------- - ----- w " --------------- • RemodeJirpg atd/or r firing (descnhe)= ---------------------------------------------------- -------- ----------------- ------------- -------- -------------------------- " ` y - -------------------- x - r --•---------------------- :• -. ---------- -----------------------------------7------ -•- I hereby certify that ['have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules":and regulations of the San Joaquin Local,Health District. - Si ned X - ---- `` __. - IOwne k c � ---{Title)---------- -------------- ----------- --- .......... ------ EY� ;:------------: ----------------- ------ (Plot plan,_showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverst .Fide). �' • �j� FOR_ _ •- DEPARTME NT USE O 77, - ------- 1 -- ---------- DATE....7-f APPLICOACCEPTED,:BY-- ----- -- DATE - - REVIEWED BY--------------------------- --------- DATE-------------------------#----------------------------- l 'Y-------------------------------------------------------------- BUILQING PERMIT ISSUED______..��__...__!_- �z Alterations and/or recommendations:-?- -------- --------------- ------------------ ' f _________________ ..___._____.O. 1--------------------------- _�` _...___ -_ ____..____________.__________.._-________..________.____...______._____.____ ____________________._.__.___.._ _--._-._- d ------ - .' ----------------------------------------------. ..--.-____---_ '. r------- ---------------- ----------------------- ----------------------- -- ----------------------------------------------------- --------------------- . ----------------------------- y --------------------------- '/�/J 7 f • "y �'�J r f�� FINAL'INSPECTIO:N, BY. � tY LDat a 'w SAN JOAQUIN LOCAL HEALTH DIS,,TTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California �� Mantecd; alifo,nia Tracy,California Stockton,California41 I• �' v