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APPLICATION FOR SANITATION PERMIT Permit No. ._o � Z (Complete in Duplicate ... S --- This Permit Ex fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Date Issued 1 ._/4.=_ .� This application is made in compliance with County Ordinance No. 549. install the work herein described. JOB ADDRESS ANDLOCATIpO Owner's Name----------- ------------------------- Address -'�'�.fs? —f-- Phone"-1/_7_7--. Contractor's Name------ ----- -�=-----•-•-- -- ---•---•--•----•- Installs}ion will serve: Residence ------------------------ Phone---�----�--��Z-%7 �'Rpartment House (] Commercial Number of living units:/----- Number of bedrooms _ ❑ Trailer Court ❑ Motel ❑ Other ❑ Water Supply: Number of baths -_-" Lot size --__ Public system [�- Community system Character of soil to a depth of 3 feet: Sand ❑ Gravel Private ❑ Depth to Water Table X1._6.-_ ft. Previous Application Made: vel E] Sandy Loam ❑ Clay Loam • (If yes,date---_ _-- ---- - ) No F-1Clay ❑ Adobe�.>Hardpan ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: � New Construction: Yes ElNo 99-- FHA/VA: Yes El No�-- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_. --------------Distance from foundation-_--__-_-_- No. of compartments.__ _-_ -•____.Material___.__--_- ----- -- -----Size------------------- - depth - --cit. ----'� isposal Field: Distance from nearest well- -____Distance from foundation/ ___- --_- -__-_Capacity".-_" umber of lines------------ ___ 6 -_.Distance to nearest lot line_.i�-_--___" Type Length of each line-------- _-o"_'_-- Width of french_--- ... \ yp of filter material- - -Depth of filter material_--/ _�!" _ Total length _ v Seepage Pit: F��__ _ - --------------------- Distance to nearest well-_- -Distance from fo ndation-_J"b-" g ---- Number of pits_.-,/_--_-_-_ _Lining matenal____QQa� Distance to nearest lot line- __--� Cess ool: _-______Size: Diamet -_ p Distance from nearest well ----------- _--Distance from foundation--- ._.Lining materDiapth_ Size: Diameter- ---- -----------------Depth--.-- Privy: _ _ ----------------------------- ce from nearest well___ Liquid Capacity_ ...............-------------------- - istance to nea ----------------- --Distance from nearest building------ ---------------------------------- lT Remodeling and/or repairing (describe)-------------- - --------------------- ------------------ - -•---- --- ----- - -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County (Signed)---------tom _ -- ---- --- --- - ._._ __---.-"___ _ ______________________--__-__-__ .__ _"----.---._ _-_-_-- y______________________ W� (Plot plan, showing size of lot, location of system in relation }o wells, buildin s etc (Owner and/or Contractor) -----------------(Title)---------- - 9 ., can be placed on reverse side). FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY -_.._ __-�' REVIEWED BY--------__- ✓� -----------:6 ----- DATE �d_ld__^ , BUILDING PERMIT ISSUE __-"-_---- --- --------------------._-. DATE ---- - ---- ----------------------------------------- Alterations and/or recommendations:---. G ----/ -/_---------------- /------ ; ----------- -----4`�=----------------------------------------------------------------- FINAL INSPECTION --BY:,.... -- - Date-- -- - ---T- -�'-��tJ --- S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street Manteca,California F.P.0 O. Tracy,California