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FOROFF! E USE: . - a --------- --- -- ----- ------ ------.. APPLICATION FOR SANITATION PERMIT Permit No. ._a�.... .-.. - - ------- --- --- - - ---------- --.. (Complete in Duplicate) C % This Permit Expires 1 Year From Date Issued Date Issued ....-_:-_lf:/_/-L-; 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, 549. JOB ADDRESS AND LOCATION----------- "h.c wS_d_h___---.--R- •-----•--_-` --- ---- �-------------------------------•------------------ Owner's Name--------- D ----•------ .- ------------------- --- ------ -- Phone-- - Address--------t Contractor's Name-----WA-&41h --- Phone .- ... . Installation will serve: Residence, Apar ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E] Number of living units: _-- Number of bedrooms --,3. Number of baths --I-- Lot size ----.--- _--- G_✓�+__. _•____________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Graver❑ Sandy Loam ® Clay Loam ❑ Clay E❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_ ____- -----I No ❑ New Construction: Yes)�' No ❑ FHANA: Yes ❑ N 01 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest .�, we ll)-- Distant from foundation-_.-). Q __-,-..Materia No. of compartments - --�-- Size---- Liquid depth-----------------l.__..-..G..�Ca�palc/it."y-- Disposal --Disposal ----_-�__-_�_______-_-_V___-_-_•_ Field: Distance from nearest well-44-010 from foundation--l0_ /.......Distance to nearest lot line_.�Q------____ b�l Number of lines-------------- _______________Length of each line.---_7.7-__------.__--..Width of trench.-___--*?-_-�--. _ __ Type of filter material----_-O-C-`-------Depth of filter material---_� --------------�� vq 0 otal length- --, '1---�1-•---------- Seepage Pit; Distance to nearest well -f-0-1V from foundation----_ / + 4_---.-_..44 Di t . to nearest lot line..-. Number of pits._._----------------Lining material_--. f4--.. _____-.Size: Diameter.___- .-_ - r ?C .Depth -------------- Cesspool: Distance from nearest weEi-----------------Distance from foundation--------------------Lining material--._.__----_-_--_---.-_..__.-----__-_. ❑ Size: Diameter------------------------------ ------Depth------------- ---- - -------------Liquld 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 regulations of the San Joaquin Local Health Disfricf. (Signed)------ � (Owner and/or Contractor) --------------------- BY Y ---------------------- --------------------- - -----(Title)------------------------------"- -------.---.. (Plot plan, showing size of lot, lot ton ., s stem in relation to wells buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----,::'.-- ��._c _-__-.-_______ --------•----------------•---------- DATE ... -./................ REVIEWED BY ----------------- --- --- DATE BUILDING PERMIT ISSUED----------------------------- - -- - ---- ------ ---------------------------------------------- DATE------------------------------ -- -------- �----------- .. AlVaf* ___ s and/or recommendations_____1 --------------------------- -------- ------------•------------------- - ------------ -------------- �- -- ------ ---- ------------------------------- -------- << f - --- - - --------- ------ -------- ------------- - r , z -- -- :. FINAL INSPECTION BYr...-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street E6.9 REVISED 6.59 F.P.0 O.ZM 6.60 Manteca,CaliforniaTracy,California