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FOR OFFICE USE: #---------- 0- ..- Perriit�Nb ------------------------ ------------------------ APPLICATION FOR SANITATION PERMIT : (Complete in Duplicate).- - Date'lssued ---------- - _ This hermit Expires 1 Year From Date Issued ---------------------------- ---- made to the San Joaquin Local Healfh District for a permit to construct and install the work herein describe Application is hereb . This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TION.... _30------ -------•-------------------------- -----------------------------•--------_---- �� ------------------- Phone___, ----------- ----------- ------ --------•----------- Owner's Name_= Lr � s ..: Address------------- ---•-- ---- r..r -------- Phone Contractor's Name._.----------- •- -_ Motel ❑ Other [IInstallation will serve: Residence E] Apartment House 1EY Commercial [j Trailer Court ❑ Number of living units:�-- Number of bedrooms _ 00, _-_ Number of btaths S--- Lot size /� � �� ft.` Water Supply: Public system [ ommunity system El Private ElDepth to Water Table � Sand Loam 171Clay Loam [I Clay ❑ Adobe�ardpan ❑ Character of soil to a depth of 3 feet: Sand F1Gravel ❑ New Construction: Yes ❑ No �FHA/VA: Yes ❑ No Previous Application Made: (If yes,date----------- R91'--------1 NoI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t . from foundation n_ ' -_ __ -Materia!_----_-Septic Tank: Distance from nearest well_-_______-___'=Distance Capacity.._=___,--------------- of comparments---- ----------,-----`Size-------•-------•----- --•-.--- qu �ep}� N �y Disposal Field: " Distance from nearest well"." Distance Length of rom e each lin e.-tion--------------"-----Distance tof#frenchesf lot lineAnk Number of lines__._____ _ E Type of filterymaterial-------------------------Depth of filter material-----______------/- .Total length---------,-------•---- q _ Distance to nearest lot li __ ---�- k Seepage Pi}: Distance to nearest well__- -_____ Distance #rorri #ound3tion_ -••- Depth t ,Yr'S'� �,�, ------------- &/ Number of pits-__/---------------Lining material__ �1t .-'-Size: Diameter-_ f------------------------------- Size:' dation---------------- -- Lining material_ Cesspool: Distance from nea --------------- est well Disotance from fours ----Liquid Capacity----------------------------gals. ❑ Diameter------ -------- -----=-- Depth ,. f IDistance from nearest building----------------------------------------- Privy: . Distance from nearest.well--------- - ---- -------------------------------------- ❑ - ------- - -- -- -- Dista�ce to nearest lot ine---------------� --•---- ----------------- ----""-- f, 4---------------------------- - Remodeling and/or reps#ring (describe:__.- -----t------------- --------------------------------------------------- --- -•--- --------- ------------------ --'-----------------'-----------"- -----'--------�-------._.----'---'------'---'--- -------------------•---,*-• ----------------------- ` # 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. � (G = /or CO ctor) ( ntra Signed)-( . (Title)--- e�—► BY: (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed an re Terse side Y FOR DEPARTMENT USE ONLY `r�/ DATE_ ------------------------- ---------------- --------APPLICATION ACCEPTED BY--------------- F _ DATE----- ------------------- - y ___________________ _________________ REVIEWEDBY------------------------------<. ---•---- ------ --------- ------------•------- --------------- DATE--------- ------------ ----------------- --------------- BUILDING PERMIT ISSUED--------------•--f-------------------- �--------------------- . Alterations and/or recommend ations:__----------------- --------------------------- ----------------------------- ----_----""---• I ---- --------------------- ----------------------------- ---••-------•---------------------------------------------------------•----------•--------"----------- ------ ----- ----------- -- --------------- ----- 7- ------------------------------------ Date_---_�-.=- ----------------------------------------- FINAL INSPECTION B :. _. *N SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1401 E.Hatelfon Ave. 300 West Oak Street � s Lodi,California Manteca,California. : Tracy,California Stockton,California ` E5 9 REVISED 8-59 3M 3-163 F.P.Ca.