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rur, Vrril t USt: ------ -- APPLICATION FOR SANITATION PERMIT Permit No. . L? •_` {Complete in Duplicate} Date Issued . -------- - - ----- This permit Expires 1 Year From Date Issued 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 L TION-------"-"- � - -_:' - C :� Owner's Name.------ / � ,/Ilt1l .. -------r'/-/-_ �G 1-57-fy Phone-'� -"�_��•� '��f w', Address- ---------- _ '_ _, / ------------------ Contractor's Name.. /C�_f...:: � �L �'I i.. ..-Y L = Phone.- } Installation will serve: Residence Q"".'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [) Other ❑ Number of living units: G. . Number of bedrooms - 1 Number of baths /.._ Lot size -_______ _ G�--------------- Water Supply: Public system ©/Community system ❑ Private ❑ Depth to Water Table J.c:} ft Character of soil to a depth of 3 feet: Sand ❑ Gravel C S_:�-dy Loam ❑ Clay LoamW:- `Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date .......1 No Z-- New Construction: Yes ❑ No 0---FHA/VA: Yes ❑ No E�j TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weU--------------__Distance from foundation.-.---- Material._____-...._-_-._-_.--_ No. of compartments-- - ---Size--------- - - - -------Liquid depth--- .- _ _- -_---- Capacity--- - -- -- _ Dispcsak Vd: Distance from nearest well __-_. ____Distance from foundation.-; -_ _� ...Distance to nearest lo+ line---_-_. Number of fines_.._ _ -----.-Length or each line.-. G '---- ----------.Width of french- Type of filter material__ � _pepth of filter material..-. 1 ._ �_ - .Total length..-__-.._ `- Seepage Nf: Distance to nearest wel Distance fro foundation.._ S -- r _.Distance to nearest lot line__.. ........... . Number of pits- / Lining material__ GC`, Size: Diameter_ .- Depth- ^ .- .--- -- Cesspool: Distance from nearest well..- Distance from foundation. ------ ._Lining material ---- -------- -- ❑ Size: Diameter- _ --- ----- - - Depth--------- - -- - - -- - �-iquid Capacity_...- --�----- - -- gals. Privy: Distance from nearest well__-- -------- Distance from nearest building ------ ----------------- --- -- 37 ❑ Distance to nearest lot line -.-. -_-. a� Remodeling and `or repa r ng (descnbe):... " `- - �" ` - y� X_1... 5 /.._ -. /__ 9� ---- - �...... 1 --------- -- ----------------- ------- to - - --- Iereby 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 rregulations of the San Joaquin Loo ,Health District. (Signed)--------- - - - -- C`�.. Owne and/or Contractor) __... BY ;- - -- ------ ----- -------- 9 ----- (Title)---_. = - _--.... (Plot plan, showing size of lot, lova+' n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE - ' - - ..------ --- -------- ---------- - ----------- - - EVIEWED BY_, -------- - -- - - - - - - - --------- - ---- - -------------- ..- ----�- ---DATE- -- -- --- -- -� ---�- ----�-- - BUJL DfNG PERMIT ISSUED----------- - -------- ---------------- -------- DATE-- -------------- Alterations and/or recommendations:------. __ __ ------------ -------------------- -------- ---- ----------- . . "--- - ----------- ---•-------- FINAL INSPECTION BY: _Gi l Date_ / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9rh Street Stockton,California Codi, California Manteca, California Tracy, California F.P.C O.