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Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ----/ 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 herein described. This application is made in compliance wi$,,9N1 ty Ordinance No. 549. ---------------------------------------------------------------- ------------- JOB ADDRESS AND XO 10.tt�------- Phone----------------------------------- ---------- --------------- ... -A�� Owner's Name__________ ..... _-.1-------------------------------------------- --------------------------------- Address------I-------of Phone Contractor's Name__________.1; installation will serve: Residence Apartment House 0 Commercial El Trailer Court El Motel 0 Other [–] hs &I----------------------------- Number of living units: Number of bedrooms Number of bat o't size - - Water Supply – Private 0 Depth to Water\Tdble -Olft- T1-- Public.system 0Community system [I er Character of soil to a depth of 3 feet: Sand El Gravel El Sandy Loam El Clay Loam ElClay E] Adobe Hardpan C] Previous Application Made: Yes El No 2--`INew Construction: Yes gj<No E] F.HA/VA: Yes [� No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank or cesspool permitted if public sewer is available within 200 feet.) nearest well � Distance from foundation---/ --------.Mat inai-----a------- ------- Ze--------Capacity--r062------ Septic jqx�k.. Distance from —---------------Size_ `- 7 -----Liquid depth----- No. of compj!�rtments_--;:.9 v I :- ------Liqu ne-0 D�sposa� Field: Distance from nearest well____.--------77�---D�stance from founclafic, -------Distance to nearest lot li!1,&*, (A ie------- mch-_001-71----------------------- / Width of trench___ C� Number of 11hes------------------ -----------Length of each lir 0109 A ----------- Type of filter material----- -----Total length ---------------------------- Type of filter �naterial__/4xv_ Seepa Pit: Distance to nearest well------'777------Distance f m foundation----AV_.Distance to nearest lot line aterial-7 A mix",."Size: Diamefer__&.g."e-------Depth_.11109-LP ------------- Number pifs_. /------------Lining rn C/ Cesspool: Distance.from nearest well-----------------Distance from foundation..--------- "- Lining material------------------------------------- Size: Dia'meter--------------------------------------Depth------_--------------------------------------------Liquid Capacity-----------------------------gals. 0- ... Distance from nearest well__________________ ______________ _---------:-- 0 --Distance from nearest building--------------------------------------- Privy: Distance:fo nearest lot line------------------------ ------- --- emo ---------------------- --- --------------------I-------- ----------- ----------- ----------------------- -------- ---- - R 'd6Id/ airing (describe):------------- ---- ---. ------ --- ----------- - --- ------- - Remodeling and/or rep - . f �_ -4--�-------------------------------------------- - -- ---- -- __ ---------------------------------------------------------I--------------------------------------------------------------------- ----------- -------------------------------------------- ----------------- ------------------------------------------------------------------------------------------------ ------------------------------------------------------------------ ---------- ------------------------------- ----------- I hereby certify that I 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. ((3vm==an4/�or Contractor) --------- ---- --- ------- -- ----------------------------------------- ------------------ (Signed) ---------(--- - -----------------------------------------(Title)------------ --------- By:------------------- -------- By:----------------_-------------- (Plot plan, showing 'size of lot, location ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY— -------- -------------------- DATE_J� _4-5_ ------------------------------- APPLICATION ACCEPTED BY E 7 ----- DATE---------- ---------------- PEVIEWEDBY------------------------------------------ --------------------------------- BUILDING PERMIT ISSUED------- - ----- – -- --------------------------------- DATE----------------------------- ------------------------------ ------------------- Alterations and/or recommendations:------------------------------------------------------------------------------------------ ------------------ --------------------------------------- ---------------------------------------------------- ----------------------I------------------------------------------------------------------------------------------------- -------- -------------------------------- -----------I--- ------- ----------- --I- ----- -------------------------------------------------------- ------------------------ -------------------------------------------- ------------------------------------- --------- ---------- - ----------- ---------- - -- -- ----- ----------------------------- --------------I--------------------------------- ------------------- ----------------- -- --------- ------ ------ --------- - --------- --- - ---------- --- -- ------ - -------- I-- -------- ---------------------------------------------------------------------------------- ----------- ---------------- Date_ --------------------------------------------- FINAL (NSP TION BY: - -- --------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT, t Sycarn-d-ie'Sfr"f $14 North "C" Street 13o South American Street 3110 We�+ 0A St sots 1,3".. - _., I TracyCalifornia Sfock+on, California Lodi, Californian Manteca,'California , ES-9-2AA Revised 8-'59 F.P Co.