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FOR OFFICE USE: � � ='+ r / ---f �-,:� !_-� C- APPLICATION FOR SANITATION PERMIT Permit No. --------- ---- - ��=� 1 --�- J 5 6 ---------25'- (complete In Duplicate] Date Issued __--- -z-�'-----�'- This Permit Ex fires 1 Year From Date Issue D�"t -� - 3 ------------------------ ------ ----------- A Application is hereby made to the San Joaquin Local Health District for a permit to,cons ruc} a. insta the work herein descr This application is m de in coin liante�with Count Ordinance No. 549. P JOB ADDRESS AND LOCATION_ -- . f phone----------------------------------- Owner's Name--=--------- ------------------------- - - ------------------- - Q_. Address------------------------ Phone_ --------------- ------------- -----------•------•-- -�•_ - - ------------- - ----- Contractor s Name-_________ __IJ--______._.- Other ❑ Installation will serve: Residence ❑�}�partment House ❑ Commercial ❑ Trailer Court [I Motel ❑ J _ Number of baths _ of size ------- �� I-- Number of living units: __-.___- Number of bedrooms �h }o Water Table Private Dep X7- ft. Water Supply: Public system ❑ Community system ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y FHA/VA: Yes O El No ❑� ., _ New Construction: Yes [�'d ❑ Previous Application Made: (if yes,dote-.___------:---.-- 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No,septi"fank or cesspool permitted if public sewer is available within 200 feet.) __ Material_-._________- --------------- .. r Septic Tank:. Distance from nearest well_________________Distance from foun atiLiquid de th______--__-_-------------.Capacity______._-__----------- - q P. Nco'-of compartments---------------- -------------------------- Size-------------------------------- Nc�'-of �d:! Distance to nearest lot line--- -------- t istance.from nearest well. . - --Distance from foundation - r� ; Disposal F' ld: Width of trench-.t --- `A umber of Gines - Length of each line - --- -- _.. ^� Total length-----1/r (q.? Lf�' R---De th of filter material_-1�----- -+- i qq ST��' , Type of fikte?-material__..-_/a - f- P s+ ee a t:• , Distance to nearesfi well__ ! L1.___-----Distance f f9u�dation__f ------ )Ce toDneap est 1 �e f } S P g Linin material---- 50-�'JC-----Size: Diameter. ------ - / �` [ -_ 1 e f�!umber of pits-------1--;= 9 �Q � . Distance from nearest well_________________Distance from foundation___---�---- ----"- Liquid Capacity_ -------------------------gals, Cesspool: ------- ❑ Size: Diameter �" r Depth__._. -----------------------------Distance from nearest building---------- ------------- (a Privy: 1 Distance from nearest well___`::----------------------------------------- -------- __________________---�-- - -------------------------------------------- -- ---------- -------------- -- ❑ t Distance to nearest lot line_-.._.._/-__----�- - �/-- Remodeling and/or repairing (describe):--_.__-------- f `Jf i _ f -- --------------------------------•--------•-------------- ---- �- ----------------------------------------------------------- - --- ------- -- --------------------------------- -- - ..__,` -------- /--------� e ar ---- - - 4 I hereby'certify�Ahat I have prepared this olf the San Joaquin Local Hee work althedone Distr ctn accordance with San Joaquin County ordinances, Sate laws, and rules ander g 4 -------------------_- - _ ---- and/or Contractor) ♦ -- ------- -------------------- caner l /�r ISigned) - � �L1 ------ y --------- ----------------------- ---- -- -- (Plot plan, showing,si f lot, location of s stem in relation to wglls, buildings, lstc., can be laced on reverse side). FOR DEPARTMENT USE ONLY DATE---------------- :---------- -------------- ` '' - DATE------ --- ---- ----- APPLICATION ACCEPTED BY__.-_--.-:=-��-�--- ----- -- --�- - - - - REVIEWEDBY-------- ------- --------------------------- - - BUILDING PERMIT l'SSUED ---------- ---- ATE ; Alterations and�or recommendations:_.`--=-- ---- } 1 `--------- � 'v = �-- -- --- i-�C i --- c� - ------- - ---- �` y�� rr-�_-- ti � .5-= � _� - -�{ - - - ----- -- ----- ---------------------- ------------------------ i u . Date--- - FINAL INSPECTION BY:-___.-- --------- S JOAQUIN LOCAL HEALTH DISTRICT .�. 124 Sycamore Street �•West.9lh Stre+� 1601 E.Hasellon Ave. 300 West Oak Street Stockton,California Lodi,California Manteca,California Tracy,California f' F.A.0 Q.