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w .. -�I FOR OFFICE USE: _ � ------ - Permit No. --" ---------I1--.-"---------------------- APPLICATION FOR SANITATION PERMIT -- --------I�----------- -----{r (Complete in Duplicate) ''/ -- . .. . �. w p Date issued -�f1----."---2-" -------- ------- rr --------------------ISI "1_.'.-_"._"_----__ ' _ This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance 549. 7JO13`i DDRESS AND LOCATI -------- -• .�__0------- ----•-------------- -- /71�/-.(9_ C-- -- �------------------- ----- ---- Phone Ownler`s Name_-" -- --•---._--.__-- �-�---- ------ ---------------- Address -------------- - ---- •- � '°� Phone Con tractor's Name i ;I - �� ------"---- ------ -------- Pho Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence [Apartment House ❑ ❑ i Number of living units-..-_/ Number of bad rooms ___"-lumber of`baths _ -- Lot size __."f-_________-." ________________T Private epth to Water Table Water Supply:Supply: Public system ❑ Community system ❑ �l Chats atter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam El Clay ❑ Adobe � t�dpan ❑ Q �ew Construction: Yes ❑ ' No (jj,�fEFIA/VA: Yes Pre Iious Application Made: lif yes,date----------- 1 No - TYPE OF INSTALLATION AND SPECIFICATIONS: _. ilable within 200 feet.) (No septic tank or cesspool permitted-if public sewer is ava I . -Mater�ai- T�CIv----------- Sep�ic Tank: Distance from nearest we}l-"---�--_-Disfiance from�faundation__��------ Ca acit Liquid de fh-------------------------- --- ----Size-------------------------------- q P. � r^ No. of compartments___.__. __. - � � ! i; EI o,�e3" --."--"Distance to nearest lot line.>��.------� Disposal Field: Distance from nearest well- Distance from foundati __--f--- ! c n / Number of lines-------- -=--J------------ �ength of each line----- -- ------- �--' Width of trench _ e---=----------- Type of filter material/ pDepth of.filter material__,1 ----- otal length_____________________ _____" Distance to nearest well t -7*-Dlsfan - fro four dation__��:_"___--." stance to nearest lot li _ - b See page 0 Number of pits.----�-------------Lining material_-- ' Size: Diameter '�� ----Depfh_ -m7-------- -4 gals. Cesspool: Distance from nearest well._______________Distance from foundation._._"_________ ----Lining materia___._--.-------------- "-------- - ---De th----------------------------------------------------Liquid Capacity--------- ------------ 9 Size: Diameter--------------------------- ---- P . �'❑ -._--_Distance from nearest building_-___-""--------------------------------- Privy: Distance from nearest wO-------------------------------- I� ❑ Distance-to nearest lot line--------------------------------------------- ------- �. INS �' / lJ. - Remodeling and/or repairing (describe)---------- ---- l jl � ---••--------"--- - s ------------------------------- l� ----------------------------------•--------•-------------------------•------------------------------------- --------------•------------•----- ------------- Ii ! hereby certify that ! ha lespandaredulations olf the San JoaquinhLoca-Al Heal#IleDistr ctn accordance with San Joaquin County ordinances, State laws, and ru g --- ��/-ate- -`---��.I'��-- - ------- -- ---- -- ------•------- ---------- ------ ---- il r Contract p or -------------------- By: •------------------ -- (fir (..g )"" Tttle (plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on.reixerse side). FOR DEPARTMENT USE ONLY �?- DAT E_ /A-/7 _ ------- ------------------- I APPLICATION ACCEPTED BY ------------- ------ ------------•------------ - ------• DATE------------------------------------------------------------ --•-- --------- ------------------•---•--------------- -- REVIEWED BY--------------------------------------------------- ------------------ DATE---------------• ------= ---- - --- ------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------ ---------------------- --- - - ! Iterations and/or recommendations: • --------------- ------ --------------------- ---------------- /- �-�1--------------------------------- Date---- ----- - --- ------- - FINAL INSPECTION B ---- -------- " SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxalton Ave. 300 'west oak street 124 Sycamore Street 205 West 9Th Street Lodi,California Manteca,California Tracy,California Stockton,California �-� - E5 9 REVI6Eo e-59 31A 3-'63 F.P.CC. -