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FOIA QFFICE USE: � APPLICATION FOR SANITATION PERMIT Permit No. ._rl�,�.1�.. ' --------------------- _ ------ ------ (Complete in Duplicate) ------------------------------------------_----_----._.- This Permit Expires i Year 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 Count +mance No. 549. ,(�JOB ADDRESS AND ATION -', �...��_,. F .. llf� 5 ----- ----------- -------------------------------- Phone-•----------- --------------------- Owner's Name---- Address.--_------------------ {�-----• ' "� •---- ------- ----------------------------------------------------------------- -------------- -------•----- --------------------- �j t Contractor's Name=- ---•-- ------ r 4- ------- Phone-•-------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherJI ❑ Number of living units:.__-1_-- Number of bedrooms.-S-. Number of baths._ Lot' size _IPP__X-1s��'______________________ Water. Supply: Public ❑ Community system ❑ Private ❑ Depth to Water Tablet. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date--------------------I No New Construction: Yes [A-"N0 :❑ FHA/VA: Yes ® 'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ I ANo septic tank or cesspool permitted if public sewer isyatlable within 200 feet.) Septic Ta k: Distance from nearest well from foundation____ _/v_j Material__C�_ .(_ �_____._._____._. p_ /J` t L..r No. of compartments--------Z.P..----------Size�.X--yl]-----------Liquid depth__--_ .-,1 —----_------Capacity_41D-0-_--_____-, Disposal Field: Disfance.from nearest well----- Distance from foundation__-��___ _____.Distance to nearest loft Number of lines------------ Length of each line_--'�f+E-- _----.Width of trench--�_7.._--_________________ Type of filter material____ �-i t_ __Depth of filter,material___,�t��__..I___-__Total. length____�_n _ ______________-___._ Seepa Pit: Distance to-nearest weiI___...,_----_7_____Distance from foundation__ l __'4___F-Distanc a to nearest lot.line_S---------- Number of pits-------Z—----------Lining material----fir �*------_-Size: Diameter:Z3.?L _.--.__beptn_> -.f' ------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------Lt"° Lining material__.-___.______________________.___ [ Size: Diameter- Depth--------------------------------------------------Liquid Capacity-----------------=----------gals, Privy: Distance from nearest.well-____._________________ _____'= _______.___Distance from nearest building------------------------------------------ ❑ Distance to nearest lot Eine 3 '' - _ =: =IT ----------------------------------- Remodeling and/or repairing (describe):------ �� ---- - ---------------- -----------------•------------------------- -------------- --------------- ------=------•-•---. (--- ------••-•----•---------------------------------------------------------------------------------- ------ 4 1 , ----------- • -- -------------------- ----------- i I hereby certify that I have pre 3 this application and that the work will be done'in accordance with San Joaquin County ordinances, State laws i r lotions of the San Joaquin Local Health District. (Signed) ' - (Owner and/or Contractor) By----------------------------- j (Title) (Plot plan, showing size of tn �f system in relation to wells, buildings, etc., can be placed on reverse.side). y i OR DEP RTMENT USE ONLY ` APPLICATION ACCEPTS - - - ---- -- --------------------------------------------- DATE-- J-------- REVIEWED BY.•... =------------------------- - ----------- - DATE BUILDING PERMIT ISSUED ---- - --- --- - DATE-------------------------------------------------------- -- / r r _ -- -��--------------------------- ----------- Alterations and/or recommendations____ _________�. .,�`___ �__ ' -----•----------------------------------------•--------•---••-•---:..------------------•-------------------•----•-------•--------- --------=-----------------------------------------------------------•-- ------------------ EE FINAL INSPECTION Y:_. ....._. .-- ate- ------- -- - - -- - - -,------------- -------------- f SAN JO UIN LO L H TH DISTRICT k 1601 E.Haielton Ave., 300 West Oak StreetN� E124 Sycamore Street 405 West 9th Street stocklon,California y' Lodi,Californy � I~ Man Ee;ca'`'California Tracy,California iJ ti `` £S 9 REVISED 8.59 3M 3-'63 F.P.CD.