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FOR OFFICE USE: 0 / / r APPLICATION F04--SANITATION PERMIT Permit No. rv/-1�- ----------- ------------------- ------------------- (complete in Duplicate) ----------------------------- .-` [ P P � Date Issued �l fir_-•This Permit Expires 1 Year From Date Issue 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. 544. ------------------------------ JOB ADDRESS AND LOCATION--------1•-0------------------------------------------------------------------ Owner's Name-------------- • T. . - -------------------- -------------------------- - ---- 11 Phone_---------_------- -------------- Address---------------------- -------11-48--------- -'------ h g.�.__Jt?_ S Contractor's Name--- -------------------•------------ --------•---•-------------------------------------------- ----------------------•----------- Commercial Trailer Court ❑ Motel ❑ OtherP Installation will serve: Residence � Apartment House ❑ ❑ �._ Number of baths -_----- Lot size ----.--��---�.-1_ -------- -x_SO� Number of living units: _ ---- Number of bedrooms __ Water Supply: Public system 171Community system ❑ Private Depth to Water Table -------- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ' Adobe Hardpan ❑ s E3 N Ox Previous Application Made: (If yes,date_"--------- -----I No ❑ New Construction: YeSX No E] FHA/VA: Ye TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Go C �Q Material ------ ------- Septic Tank: Distance from nearest well------ from foundation____ _ _ l ' !L --Size-------- -XI-o-------- ---Liquid depth"--------------------- ---Capacity.,-.9-C. of 4 pj _ -5- ---.Distance to nearest lot line--1_____•----_"-- Dis anal Field: Distance fromrnearest well-_____ ___�-._Distant of from line foundation Width of trench-__-__._____,_`�--------------- Number of Imes--------------------------�--"Length fI i Type of filter material_____ST`----OX_kDepth of filter material------ i __..--------Total length-------- _ Seepage Pit: Distance to nearest well__-----------_--------Distance from foundation--------------------Distance to nearest lot line__-____-_-.____-_ ❑ Number of pits----------------------Lining material--------------------- Size: Diameter--- -----Dept k--------------------------------- material Cesspool: Distance from nearest well------------- from foundation.___-_-._______..Lining mater•say_------------------- -------- als. ❑ ------ Liquid Capacity g Size: Diameter---- --------------- ---- ----------Depth --------- ---------= -------- ----------- Privy: Distance from nearest well___-__.__________________________-. _____------Distance from nearest building------______---------------------------- ❑ Distance to nearest lot line__-------------------------------------------- ----------------------------------------------------------------------------------------------------- ---------- __ _------------------ Remodeling and/or repairing (describe): ---------------•------------------------------- ------------------------------ ------------------ ---------------------- f -------------------•----- --------------------- 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. (Signed)_ T. , 10 2 A I 0 INC { it1 (Owner and/or Contractor) ------------ - ---------------- -- _ --(O d o or - --- By:---- - �(V7?W e-------- -----T e [Plot plan, showing size of lot, location ystem in rela • o wells, buildings, etc., can be pla�=nreverse side). FOR DEPARTMENT USE ONLY // p - = ---------------- - DATE----/--f 1a ----------------------------- -- APPLICATION ACCEPTED BY.....-..je - . - -- f "" REVIEWEDBY------------------------- --------- -----------------7-------------- ✓ DATE BUILDING PERMIT ISSUED-------------------------------------- -- t f� Y-20.1- Alterations and/or recommendations------------------------------ ---------------------� F �� t ------------------ I ---------- -----------------------4_.e=.f l� ..________________________________________________________ _ _______-_ F ----------------------- FINAL INSPECTION BY:..- - -- ----- Date_..! "' . - SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.MoTalton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street _ Lodi,California Manteca,California Tracy,California Stockton,California J}^' F.P.0 O.