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Fj�R -------- ANCE USE:, � � L` _ .- �_3 _ . Per No. _. .... - ' APPLICATION FOR SANITATION PERMIT .. :r ------ ------------ (Complete in Duplicate) Date Issued ______________ 3 This Permit Expires 1 Year From Date ssue Application is herebymade 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 Ordina No. 549. JOB ADDRESS D LOCATION.______.__ �,�4 Phonaef Owner f Address----_-------_----- -----•-------- ----•--- Ph one Contractor's Name___ G _ artment House Commercial ❑ Trailer Court [:] Motel ❑ Other ❑ Installation will serve: Residence M,-AP r� Number of living units: __�__ .Numb of be drooPs ." r`[umber of baths _ -_ Lot size __ -- -. Water Supply: Public.system Community system ❑. Private ❑ Depth to Water Table& ft. ❑ y ❑ y Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam Clay ❑ �I NConstruction: Yes El No Np+/vA Yes El No ❑ Previous Application Made: (If yes'date------------------- ) No El -New Ir TY"F INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool-permitted if public sewer is available within 200 feet.) i " _ Material- ---- ----------------------,-- --------- ----- Distance from.nearest well_________________Disirance from foundation-_________ _"____ -. Capacity______ "--------------- I No. of compartments------- ------------------Size------••---------------------- Liquid dept - posal Distance from nearest weil__i�'dhAJ-Distance from foundation_ ---------Distance to nearest lot line_____ r -----.Width of trench.._- !�------------- � Number of fines_--"__�__ _--" _____--- - Length of each line__o�-�-"- ----- i Type of filter<materi __ _ .c� � --Depth_of filter material__ _-__��"1f--Total length_____ 0----------------- ------y page its Distance to nearest well- _ice Distance f ation �" Distance to nearest lot line______ ?--_--.- !/ 1 �_ Q`7 Number of pits...i-----------------Lining material __ _ Size: Diameter---.- --.- - Depth --- ,. n Ce ss pool: Distance fromnearest we}!- ""-"-"_--""--._Olsten m foundation__.._______"______.Lining materia__.-___"_______________ gals. E1Size: Diameter--------------------------- - --------- Depth----------------------------- -------Liquid Capacity l i Privy: . -----------------------Distance from nearest building-------------------------------------_--- rw Distance from nearest well-_.._.._______________" ❑ ------------------------------- Distance to nearest lot line_______________" -------------- - Remodeling and/o repairing (des ibe):____" "-- "- _ --------------------------------------------------- C I hereby tfy th I have Q ared this application and that the work will be done in accordance with San Joaquin County ordinances, I s, d rules, a r gelation oft an Joaquin L ealth District. ' � -----------------------_Owner and/or Contractor) (Signed --------- ----- - =-------- - - a l �= f ------- -- - ------------ t By:------------------------ -------------------------------- --------- {Title) (Plot plan, showing size of lot, location of system in re! on to wells, buil ngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ,� ,.GGae --- DATE.-------- � �'�r G3 I, REVIEWED 8Y----------------------------- 1 DATE------------------------ BU I LDI NG PERMIT ISSUED----------------------------------- - ------------- •---------------------- ----------'DATE- --------------------------------------------------------- Alterati sand/or recommendatia s:______________ ___.._._______ ------------------------= � J------------------------ -------- --- --- 1 r.`----- ---- -------- -- -------------------- ---------------- ----------------------------------------------------------- --------------------- ---------- o �7 Date-_. . . ----------------- FINAL INSPECTION BY-----------Cx-- ,mac- ---- ISAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h Street Sfocklon,California Lodi,California Manteca,California Tracy,California ES 9 R6VICED 8.69 3M 3•'63 F-F'Co-