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FOR OFFICE USE: p r do 1 Permit No ��. APPLICATION FOR SANITATION PERMIT ----- (Complete in Duplicate) /� ;3d�,� Date Issued .'--"-•-------•------- ~�- --------------------------------------------- - -� ---- -------------------- This Permit ExpiresA Year From Date Issued u Application is=hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descri e . ,.,..,....This application, compliant e,with County Ordinance . 549.. ,. f -- �C�(-------------•------- JOB ADDRESS AND LOCA ON-----! -�- ------------- ----- Phone."4 y 7 Owner's Name-------------------- - ----- Address----• ---• -- Contractor's Name____.___.___.__""____ - one -- ------ --- -- ------------ ------------- ----------- ._.__._t __ 1 F Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ` Installation will serve: Residence �, f r 1 Number of baths -1----- Lot size ----&A2--- -----� �f I Number of living units: ____�_._ Number of bedrooms .- gyp( ft. Water Supply: Public system Community system El Private ❑ Depth to Water Table " I Clay Loam ❑ Clay ❑ Adobe (6 Hardpan ❑ I Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam 0 4 Y Previous Application Made: (If yes,date----,___"",.---"""----) 'Not -� New Construction: Yes ;.El Noy FHA/VA: Yes ❑ No M TYPE OF INSTALLATION AND SPECIFICATIONS: r tic tank or cesspool permitted if public sewer is available within 200 feet.) r (No sop P I I om artments r 5ie iquid'8e�th 'MatersaL- Septic Tank: Distance from nearest well_______________" Distance from foundation__.-__"_"____ _____.( Capacity_._._____.-.___.___..- ❑ �t JJGNo. of c p - - - - bis' Disposal Field: Distance from near st well__.,_-,_.;'r-Distance from foundation, ---------------`Distance to nearest lot line_______.____._._ p 1 r.; - E Lengthiof lWidth of trench----------------------------------- F-1 --- ------------ -- --- ------ ❑ &X151f�1J�' Number of lines_________ _ ., - - -- ----------------- f"__De th.of filter material_.---------------------Total lengt ------------------------------------------ Type _.-__.- ___ _ _ ___ Type of filter material__ - p� r p g Dista fce to nearest lot line-.�_-___---- See a e Pit: Distance to nearest well___.01dj 7--Distance om - Size. Diameter-,_13": - --._--Depth_-2 ' --------------•--- Number of pits - - - r s Dol: Distance from nearest well...__ D.sta I _ " "____Lining materia Ces p -----"- 'ee from foundation------------- -------Lining material------------------------------------ Cesspool: ___-.._..--------- ----""" -als. 1 ----------------- Liquid Capacity. --------------- 9 ❑ Size: Diameter---------- I t r- ------------------Distance from nearest b0cling------------------------------------ Privy: ---'-- Distance from near�st well_-".'__��"--""--- - Distance to nearest lot line------------- ----: - a ---- -- •-- t Remodeling and/or repairing (describe),------- f ------------------------------------ -- -------------�_---,� �; -- I hereby certify tPIp pr; a�ed this application and that thhe work will be done in accordance with San Joaquin ounordinances, State lawss and regulatio of the San Joaqui ocal Health District. I Owner and/or Contractor] (Signed) ------------ - - --------(Title)-------- -- - -- -+--- ---- ------ -- ---- - --- -- - in to wells,- buildings-, etc., can be place on reverse side). (Plot plan, showing size of o , ocaFion of systemn re FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY---- DATE.__L_a _'-__ _ 2_77a-4 - - --- -- ----- REVIEWEDBY------------------------------ �- ------------:------------------- DATE BUILDING PERMIT ISSUED-----------1---------------------------- -- ---- ------ -------------------------------- DATE--------------------------------- Alterations ---------- ----------- ------ - ---------- ------------ Alterations and/or recommendations:------------------------- ---- ---- ----I---------------------- ---------- ----------------- i -------- �-�� ---•---------- ------------ --------- - --------- FINAL INSPECTION BY:.---- -- --- ----- - Date---- ------- --------7-,---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1661 E.Naxelton Ave. 300 West Oak Street 124 sycamore Street 205 West 91h Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.CO.