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F R OFFICE USE: ' �,p - Permit No. gZ APPLICATION FOR SANITATION PERMIT s-`F---------- _-- - -- -- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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 LOCATION ------- �' � RIe--------------------- ------------------------------•---------------------------- - Owner's Name. p;• -------------•-------------- ------------ -------- Phone_ ' --------------------------- Address--------------VT.A 49911 ---- '�-.4/�•----------------------------------------------------------------------------------------------------------------------------------- Contractor's Name---------- � �� 1 --------------------- •------------- Phone..--.-----------------------------. Installation will serve: Residence R4---Apartment House ❑ Commercial ❑ . Trailer Court ❑ Motel ❑ Other ❑ ti or Number of living units: J--- Number of bedrooms A.._ Number of baths-_ '_.Lot size-�rf�--x/49d9-------------------------- -- le Water Supply: Public system R�ommunity system [I Private epth to Water Table 6_�'ft V Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q Clay [-] Ado F]be grliardpan Previous Application Made: �Ilf yes,dote------------ .-] No R�—New!Construction: Yes ❑ No 99--FHA/VA.. Yes ❑ No`;_ TYPE OF INSTALLATION AND SPECIFICATIONS: No Septic tank or cesspool permitted if public sewer is avail able within 200 feet.) [ p P Septic Tank, Distancel:from nearest well________________ Distance from foudatioq_-.._______ ____. Material__..._______ _p__.__y_.____--.----__-____'. �t49Y�V No. of compartments- - --- ------------------Size---------------• Li; uid depthp »� acit ---------------- - --------- / Y_____-.Distance to nearest Iot�Gne.__+�~ Disposal Field.: Distance from nearest well...t�__�___Distance from foundation_____-__ ._ - g"f 0f,0 Number of lines________________ yLength of each1line___-- 4`W--- --_____.Width offrench-----�2__________________________ p �� Type of filter material---4,6�/�-Deptit of filter material__.� _____._..Total I ------ _____________or______ 7f" f i ! ' far e t �.tSeepage Pit: Distan�ceto nearest well___ _.Q_.__` Distance from fou dation_�A__ _____.Distanearest ine_t�9/ Number of pits._.__- _______Lining material_,�r�7__ _ -- ize: p ---- Cesspool: --• "� ss ool: Distance from nearest well_ __ 1Distance r0 oundat on `ameter- 'Lining material________________________________.___. Ce p ❑ Size:fQiameter---- -!--- - . '--Depth-- - "=------------ ---------------- �--------`Liquid Capacity----------------------------gals. If l r -- -------------- Remodeling _-- -- Distance from ne rest building__ Privy: Distance �rom nearest well--'-------- -- --- ---- -- - - ---- -- ----------------------------� ❑ -� ) ---------•---------------------------- ------- Distance to nearest lot line = ,-�# a d/or repamn desc - ----------- _ -------s--- I herebycertifythat l�'have prepared this application and.that the work will be done in accordance with Sart Joaquin Count ---------------------------------------------p p pp y - ordinances, State laws, and-rules and regulations of the San Joaquin Local Health District. �j/"-- {Q Lor Contractor (Signed)--- ------- � R .. - ------------ B . ._ -----------(Title)- .rte------- - - ------- ------ - - --- ----- -- --- --------- lam (Plot plan, showing size of lot, locaQ#n!of system in rel on totwells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY v APPLICATION ACCEPTED [3Y -------------------- DATE--------- REVIEWEDBY--------------------- -------------------- -------------------- -------------------------------------- DATE----------------- ----- ----------------------------------- BUILDING PERMIT ISSUED__---- 'st- DATE Alterations anal/or recommendation0 �------- -------------------------------------- ; ------------ ---�------------- ------------• -----•---------•- ------------------------ I ------------------------------------------------------------------------- ------------- ---- -------- -- ------------ --------------------- -- --------- ------ --- ------------------------------------------------- FINAL ------------------------- ---------------------FINAL INSPECTION BY: Date-__.�.!_u.Q�------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak street° 124 Sycamore Street 205 West 9th Street ° Lodi,California Manteca,California! Tracy,California ' Stockton,California ' F.P.0 0.