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FOR•OF>'ICE USE: Permit No. .. APPLICATION FOR SANITATION PERMIT --------- ----- --------------- --------- ------ --- !: [Complete in Duplicate) pate Issued .��.•�---C--�-- ' This Permit Ex fres 1 Year From Date Issued -------------------- ---------- ... Application is hereby made to the San Joaquin Cocal.Heal�h District for a permit to construct and install-the herein descrbe . p This application is made in compliance with CountyDin�e•N�• 549. I ------------------- JOB ADDRESS AND LOCATION------- _ -A---- ->"._ Owner's Name--__- Cl- Cc _ .. kA---------------------------------------------- ----- y •---------•-•---------•----- ..... Address-_ I _D------- - + Q_C�_ ------ i --- •------•-- Phone -----.._. Contractor's Name_.-----0AQ_16S- ----"'---------------- •---- """""--- Trailer Cour} [I Motel ❑ Other ❑ nstallation will serve: Residence S Apartment House ❑ Commercial ❑ Number of living units: __ Number of bedrooms -Z.. Number of baths -____.-- Lot size ___i_ o_-•-- ••-• Water Supply: Public system FK Community system ❑ Private [IDepth to Water Table ft. Adobe®, Hardpan ❑ Gravel Sandy Loam ❑ Clay Loarm ❑ Clay ❑ Character of soli to a depth of 3 feet: Sand ❑ ❑ VA: Yes ❑ No & Previous Application Made� [If yes,date--------------------) No �]. New Construction: Yes �, No ❑ FHA/ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (.No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well:__i�.vn-�Distan qe from foundation-- titin--_ depth-_M48ria1.--C._Cap�t�•A- Z_Q No. of i'compartments_-------Z.------------Size__' _ls.l q L1 Disposal Field: Distance from nearest well___1� -�--.Distance from foundation.:.-_1_�t--..---.Distance to nearest lot ine___ __.__.._. mber of lines___._-- --------Length of each line---.-r��-----•i-----...Width of trench.___.--�-- Nu �---- \ ^ --------Depth"of filter material___---i-6----------Total length-:--_�--4Q----------------•------- Type of filter material--- V fo i Seepage Pit: Distance to nearest well_____.-_____________Distance from foundation.__________________Distance to nearest lot ine__.__.___._._.... Number of pits t Lining material.---=-• .+--...... ----------------------- ""Size: Diameter Depth ❑ ., : Cesspool: Dista rice 'from nearest weil_________________Dlstance frorr+'�foundation____________"______.Lining mafieria-------------"------------"--"-.•als. `' Liquid Ca aci 9 Deth-------•-------"---------------------------- q p tY ❑ Size:--Diameter------------------ ' p I ��' �,-- Distance from nearest building--t-------------------•••---•------------- Privy: Distanta from nearest well----------------------- ---_---------_---_ ❑ Distance to nearest lot ine__.__.___-------------------------- ------ scribe): � F ---•----------------•--- Remodeling and/or repaiing (describe:_#----.----•--------- -------------------------------------------------------------------- ii. - ---•--------•--------•---•---•---•- --- ________---------________R --"-----------------•--------•--------- ------------- I hereby certify thhave prepared this applthat the ,icotio!_and work will 6e done in accordance with San Joaquin County af;I " ordinances, Sta laws, and rules nd r Jlations of the.San Joaquin Local Health District. {Tit e (Owner and/or r Contract ------------------------� --------- -------- -=- (Plot plan, showing size of lot; location of system in relation to wells, buildings, etc., can be placed on reverse side). II , FOR DEPARTMENT USE ONLY ± 5.--------------------------------------- DATE L, I APPLICATION ACCEPTED BY_ C �. ._"_ `e DATE------------------------------------------------------------- REVIEWEDBY----------------------------------------- -------------- -------•----- BUILDING PERMIT ISSUED--------_-------------- ---------------•---------------------------- - _ -l-K s ••- �' itaax r �i--- - --------- ----•-- Alterations and/or recommendatians:___I______. -_-$ -- �'---_.--_•-_---_---.__ I Nf�a__ k i2--• ��'`�` !` ' i ---------- !' •--------•-- R �. --- ------------------------- .. ._-------------- i FINAL INSPECTION 'BY:.____._------------------ �i SAN JOAQUIN LOCAL_i EALTH.DISTRICT 'i " 130 South American Street 3205 West 9th Street 00 West Oak Street 124 Sycamore Street Lodi,California Manteca,California Tracy,California Stockton,California E6.9 REVI9M 13•59 F.P.0 O.2M 6.60