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-----�_ FVCOFFICE USE:----- �� H - - --- r. -�.-__-___3�.- �1 APPLICATION FOR SANITATION PERMIT Permit No. ...1.r�(7 ------------ ...........r-- - >r-e- f r`3 (Complete in Duplicate) ------ This Permit Ex fres 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 Count Ordinance No. 549. JOB ADDRESS AND LOCATION.. ry �e.......P�---.!'[/a__ ------'�F_ Phone Owner's Name---- p�.-2 ------ --------------------------- -------------------- --------------------------------------- Phone.................................... ------ Address-------%S.awQ✓,......••-•--.----------•-------... Contractor's Name f" •`� Phone- ---•S-._ L 1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ -. Number of bedrooms -- Number of baths. !_.-. Lot size , .. _ f"f�•:-•.--.-___•....................... x Water Supply: Public system ❑ Community system ❑ Private [Depth To Water Table jW_`ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe[i<ardpan ❑ Previous Application Made: (If yes,date--------------------) No I New Construction: Yes J200"No ❑ FHA/VA: Yes F�TNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Y R i (No septic tank or cesspool permitted if public sewer is available within 200 feet.)` /� 1 Septic Tank: Distance from nearestjwe.l--.,?W-- Distance from f ndation.-/ --. terial--.01 No. of compartments_ _ __________f Size iquid d l th---M P . Capacity r Disposal Field: Distance from nearest well./R_ Distance from foundation.-_-__---.Distance to nearest lot line_-_..... Number of lines___...__ - Length of each !� Width of trench.,A-.-------------------------- 1 Type of filter material � _Depth of filter material_._- --_--_-..Total length__/, 7--- Seepage --�_____________________. See a e Pit: Distance to nearest well--- -._ -- P g _..__Dlstance from f undation__..' ..__._..Qtancefnearest lot lie_„ `...._. 4?e Number of its--- -- L7 P �-____-.-_. -_-Lining`material �--_-__Depth-_��__�________ _--_-_.__Sizei Diamete --.-___ (� Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------._-_-_,r------------......... ' �•- ❑ Size: Diameter---------------------------------- --.Depth-------•-------------.-.-_--------------------------Liquid Capacity---------------------------- r Privy: Distance from nearest well------------------ ------------------ ----_-Distance from nearest building-----------------__..__-.-__----.--------- ❑ Distance to nearest lot line-----_------------- ---- _ -- ------ ------------------ -----------'---...---•-----`------------------••------------------------- ------ ti, 1S i Remodeling and/or repairing (describe):------ r ••--------- ......------------•---------- ---------------•---- ------- ---------- r --- yyl --------------- I hereby certify that I have p par this application and that the work will be done,ir�accord a with San Joaquin County + ordinances, State laws, an rules and, rag ations of the San Joaquin Local Health District. (Signed) . ltd/or Contractor) By:---------------- ---------------------------------------------------- -------- (Plot plan; showing size of-lot, location of system i ation to wells, buildings, etc., can be p al ced,on reverse side). FO ,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ---- --- - = ----=-- DATE-------- ---- REVIEWEDBY----------------------------------• --------------------------------------------=--------------------•------- DATE.._.. BUILDINGPERMIT ISSUED-----------------------------------.-------------------------- ---- --------------------- DATE ------------------------------------------------- Alterations and/or . ---- ------------------ µ �.- ._ q-- .5-( --------------------------------- ------------------------------------•------------------- --------------------------•---..----------------------•------•--------------------------------------------------------------------------------------•--•-------------------------------------------------------------------- --------------------- --------------------- FINAL INSPECTION BY --w Date..-.._.----•-- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 124 Sycamore Strout 305 West 9th Strut Sfockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 2M 5-62 ATLAS