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111 FBI- 710E USE: �044te ' PPLICATION FOR SANITATION PERMIT Permit N0.----------- ��; (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date slue 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. ii��// Q�----�G ,rr,� ------------------------------------------------------- JOB ADDRESS AND LOCATION-.-l__1_- Owner's Name--- Address < . f� �� ' 04;e�- ---------------------------------------------------------••--•------. •-••-•---- Phone-------------------------•--------- Contractor's Name---_ ._ ------------------------------------------------ Installation will serve: Residence �partment House ElCommercial ❑ Trailer Court �e / Number of living units: .0_-- Number of bedrooms -- Number of baths .__._.. Lot size ft. Water Supply: Public system Community system 11 Private ❑ Depth to Water Table ardpan C]Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam Clay ❑ Adobe_ FHA/VA Previous Application Made: (If yes,date--------------------) No ��'New Construction: Yes ❑ No @9� : Yes ❑ No 4P" TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .. Material--------------•-----------•-------•-------------- Septic Tank:i Distance from nearest well-----------------Distance from foundation__________ _____ _. /l,fcr�f14t4-f No. of compartments--------------------------Size----------- Liquid depth Capacity Distance to nearest lot line._.?�.I__._....... Disposal Field; Distance from nearest well---- Distance from foundation.. -- Width of trench_A-!—----------------------- ,�Len/Length of each line__.'J�_0---- /f� IG -- Total length A----- ----------------- �Al �� Number of lines_____________"_-- ----- -- g � _ ___�L - Depth of filter material__ ---------- g - . �� Type of filter materia 1 See a e Pit:, Distance to nearest well_.__'"'"--------Distance fr fou dation__l ..Distan�c9 to nearest lot IiPe___ -•-----•- p g Size: Diameter_t '. ------------ -- - Depth 1) -- 0 ' P/+ Number of pits....... material_. --��% --- Cesspool: Distance from nearest well-----------------Distance from foundation_--_.-____."___---.L�nuid Ca Capacity gals. ❑ Size: Diameter---------- ------- -------------------Depth---------------------------------------------- q p Y Privy: Distance from nearest well-_____.-_-_"_____________ ___"-____-__.__._-._Distance from nearest building____-_--""_"---------------------------- ❑ ----------- Distance to nearest lot ine-------- ______�-------------- --- -------------- ---- -- ------------------------------ Remodeling and/or repairing (describe):__._.__.'_ ____ ___---_".-_•-"_____________________________ -------- ------ ------ ---- ------ --- ---• ----" - -----------------"- - I hereby certify that I have prepared this application and that the work will be done in accordance wi+h San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �rontrac C for} (Signed)------------------------------------- + r !"'" ---- ------------ --(Title)---- ��---------- -- -------------- (Plot plan, showing size of lot, location of sy in relation to w Ils, buildings, etc., can be placed on reverse side). FOR DEP MENT USE ONLY DATE /� APPLICATION ACCEPTED BY--------- --- - DATE BUILDINGPERMIT ISSUED--------------------------------------------------------------------- -------•------- -------- ----------------------- Alterations and/or recommendations---------------------------------------------------------;--------------;--------------- � --- -------------------_- ---------------- -------- ----- - 1 k �-�---- y �� r ------ - -fir _. 6.7 ---------------------- . y -> . ------------------------- -- � Date------f� A6�_1------------------- ----------------------------- FINAL INSPECTION BY:----"...-- --------------------� - ----- SAN JOAQUIN LOCAL HEALTH,DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 209 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California REVISED B-59 3M 3-'63 F.P.CD.