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FOR OFFIC- USE: APPLICATION FOR SANITATION PERMIT uPermit No. ---------- ----------------- ------- - ------------ ---------------- (Complete-in Duplicate) w Date issued 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. f This a plication ids made n co p with County Ordinance No. S49. +� t -�� ------------- ---------------------------- JOB ADDRESS AN LOCATION----------------------------------- 1 •�, --- -------- --- Phone-�.'G_._�--�-'-��•-�1--- Owner's Name--------------F&U-�--.--- ! k'l� 5 ----- C e - ----- Address.----- ---<- - - -- _ X Contractor's Name----- --- ------------ --- - �------------�- Phone ...--. Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ! t .- Number of baths- - Lot size ---------------------- Number of living units: __L -- Number of bedrooms _� ; Private Deptb to Water Table �rft Water Supply: Public system ❑ Community system ,� Character of sail to i depth of 3 feet Sand � Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ 1 _.•- No-."_-- ---_-- } New Construction: Yes:�o-❑ FHA/VA: Yes Previous Application Made: Ilf yes,dateNo ❑�� TYPE OF INSTALLATION.AND.SPECIFICATIONS; i s . k or cesspool permitted if pu - ' eptic—tank sewer is Noavailable within 200 feet.) Septic Tank: Distance from nearest well-/ _.....Distance from founclat -------- No..of compartments-- � .-----------Size- - -------x---7---------Liquid depth-..-.7_ - Capacity_1�� • Disposal Field:- Distance from nearest wekil ®- Distance from foundation--- - ---------Distance to nearest lot line-_�S_-------- Number of lines _ --1----------------'1-------Length of each line--/�0----=------ Width of trench_. -------------------------•-- Type of filter material._~ ... . .--Depth of filter material_.- --____-------.Total' kength---.��_ _�------------------------ r Seepage Pit: Distance to nearest well. ation--------------------Distance to nearest lot line---.-----_ ................".-._Distance from found _--.-- Size: Diameter �^— ------Depth- - ----------------------------- i - ❑ Number of pjts.-- ----------------.Lining material--------------- ---- Lining material------- ----------- ------------- E Distance from nearest well Cesspool: ----------------Distance from foundation--- ------ --- ❑ Size: Diameter- -- -------------- ----- ------Depth-- ----;-- -------------------------Liquid Capacity..-------------- gals. Privy: Distance from nearest well---------------------------- -- ------------------Distance from nearest building--------------------------------- ------- , Distance to nearest lot line ------------------------..... ......... ---------- -------------------------------- Remodeling and/or repairing (describe)'--------------------------------- ----------------------------------------------------------•---------------------------------------- ----------------------------------------- ! 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 r guI tions of the San Joaquin Local Health District. { - /— ' - .erand/o rContractor) - ------- low, {Si ned )--_----- �_------- -- ............ By:------------------ -.r... (Piot plan, showing size of lot, location of system in relation to wells; buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -- -- -=---------- ............--------------------------- DATE-------- - '� ----------------------- REVIEWED BY------"------------------ - ----- DATE DATE. BUILDING PERMIT ISSUED-------- -- ------•----------- ---------------- ------------- ------------------------------ Alterations and/or recommend ations—------------------- --------------------------------- ------------------..--• ------ ------------ --------------- ----------------------------------------------- ------ 't . - ---_ .---- ....... - ••_•- ... .-._ - •• -- ---------------•----------------------- Daten N FINAL INSPECTle- Y... _ - _ - aJ -- - -- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore 5lieet 205 West 9th Streelre Lodi, California Manteca,Callfornia� Tracy,California Stockton,California --�- E.K.9 21%1.67 Vanguard Press 1 •`