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FOR OFFICE L1SE: 11 APPLICATION FOR SANITATION PERMIT Permit No. ... � �-•-- ---- ---------- I. (Complete in Duplicate) Date issued ll fel-•--• -------------------------- - I l9e This Permit Expires 1 Year From Date Issue s� Application is hereby made fo the San Joaquin Local Health District for a permit to construct an�mstall thew r3 erein described. This application is i c.Wnpiiance with County Ordinance No. 549. t �" fSI DIS AMF -IN - _ 1 JOB ADDRESS AND L CA,LON.• Q ( �� -----H---- fz``� I! Phone--------------------- ---- Owner's Name _ l �_ �_ .�` _ f - --, �c ------------------------------------------------------ Address------ _ rtment House Cdial ❑" Trai e --------------------------- Phone Contractors Name______________ ' -------- ----- 'II ra r Court ❑ Motel `Other ❑ Installation will serve: Residence JApa / j Number of living units: __�._._ Number of bedropms Number of baths __._____ Lot size -----!- _ __ 1I ZrL� f. Water Supply: Public syste11:m ❑ Community system ❑ Private Depth to Water Table,,!* Character of soil to a depfH of 3 feet: Sand (Gra%vel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made. (If.yes,date_...-,-..---._..-.-"_) No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No r�' i TYPE QF INSTALLATION'A<VpD SPECIFICATIONS tic tan1C r cess ool ermi}ted'if publl war is available within 200 feet:) (N;—se p s r F, l 'f r•' r -- ---- --- Septi Distance from nearest well__-�J_�1_ .ais}ante from foundation---f� Ca acit Z0-0-_ ' a No. oV ompartments��____V' ''1- lie 4f 1i!_ja--X_ Liquid depth----- - -Z-:---- p Y �. r 4 _._ rr Disposal Feld: Distanc� from nearest well_ _ ._DlstanCe from foundation____."�p-�tance to nearest I t line_____ _ c7_-}- dth of trench__-__ Number of lines-----------�—:: Length of�each line 7 c Total length Type of:filter material___ � - -Depth of fslter material_____�__�- --- 9 �L�Ei i I ii Seepage Pit: Dist a �a._---.Distance to nearest lot line_�- --� r k ndation___-- •-- --• _ r '� tancle to nearest well_ lQ_---_-_--_Distance from fou Size: Diameter --_"-----Depth---- -----f---------? Nurmbe of pits.-.----!_ __:___-_'Linirig'matersal_ --— I ,. ' Cesspool: t Distan�eFfiom nearest well----------- from foundation___.______________.Lining maternal________________________--__________ '•� ❑ ----De th-------------- -------- `=; �L`quid Capacity gals. '"�'"` > Size:raiameter------------ ---------- --- - p .. z'! ' s e:, ;I Distance from nearest building A Privy: -Distance from nearest well____..______.-____- ❑ Distance to nearest lot line---------- ----------------------------------------------------------- 4 ---------------------------- -- ----------------------- = ------ '�M -------------- Remodeling .,arid/or repairing (describe): ------ ------------------------------ --� ;�� ------------------------------ ------------------------------------------- ---------- ' t -----I--------------------------------- ,• >u: } . I hereby certify that IFheve,prepared4t is application and that the,work will be done in accordance with San Joaquin County ordinances, Stated . and rules regulations of the San Joaquin Local Health District. -__.-_.__..(Owner and/or Contractor] I (Signedl � ------------------ ---------------------- -------- ----- "" _. .. '. [Title) -- - •-- (Plot plan, sh 3 in; size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORJDEPARTMENT USE ONLY a' . --- --- ------------- N ACCEPTED BY__. .R_„.0------------ ---- ......... - DATE REVIEWED BY----------------- ��l----------------------..--- ---- ------------------------------------------ DATE or recommendations: -- - -------------------------- --------------•------------------------------------- - ----- ------------------------ DATE----------------=------ _ ---=�----- BUILDINGPERMIT ISSUED---------------------------------='-------------- ---=--=---- ---------- - I Alterations and -------------- -, - % t .. �.: - I -- --------------------------------- ---------------- ------------------------------------- --------- ------- 1 --- ---- .... - -------------------------------------------- - : ---------- -- - -- ------------------------------------ j FINAL INSPECTION � --------- --- ---- Date... /_--1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton A1''.. 300 West Oak Street 124 Sycamore street 205 West 9th Street 1I. Lodi,California Manteca,California Tracy,California Stockton,California .r�