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Permit No -• • __... 41� Perm APPLICATION FC, SANITATION PERMITT s Com le#e in Duplicate) Date Issued - p b made to the San Joaquin Local Health District for a_permit to construct and install the work herein described. Application,is hereby z This application is made in compliance with County Ordinance No. 544. f / r JOB ADDRESS AND OCATlON --------------- Phone----•---- --------- 4- I __-•__ -.-•------• Ilhh==--GG -_..r ___________________ Owners Name_ w ----- ------= ------------- _ 15 Address------••----: Pone. - - ------.'`.'- -- ---�-- - - Other ❑ Contractor's Nama_---- -__-1-- -- Commercial ❑ Trailer Court ❑ Motel ❑. Installation will serve: Residence I Apartment House ❑ . " :e _ -------- ------ Number of living units: __ _._ Number of'bedrooms _ -= Number of baths --.--- Lot size ------ ---- Depth to'Water Table� ft. Commuriity'system,❑ Privafie ® p Water Supply: Public system ❑ ' C}a Loam ❑ Clay ❑ Adobe ] Hardpan ❑ 4 Gravel ❑ Sandy Loam ❑ Y Character of sail to a depth of 3 feet: Sand ❑ New Construction: Yes [ No ❑ FHA/VA: Yes ❑ No ❑ i. . Previous Application Made: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer available within 200 feet.) Material._._._._____------------- '- .. t Distance from nearest well----------------`-Distance from foundation uid depth---------------- Capacity..__------------- Septic Tank: � ---- � � No. of compartments--------------------------- ----- ----------------- ize----•-------•--•----- -- - -.--Liquid a Length of each line Width of trench Drs osal Fie}d: Distance from nearest well---------- ----- Denance from foundation--------------------Distance to nearest of me________-_-.__._ � `'t''' Number of lines = ------------- g ------- Y,:5 f- _ Depth of filter materia!--------------------�"3otal eng ---------------------- - Type of filter material----------- -------- -- p r, _ �___ •._-_- Distance to nearest lot�lirie - G Distance to nearest well_1 --- --- - Distance from f undation Seepage Pit: d. Z, -Linin material,��'"� -'-�-----Size: Diameter�:_.�"�---�- p Number of pits.___'_-- ----- g Cesspool: Distance from nearest well-------------- Depth from foundation ------Liquid Capacty____----------------------gals. [� ❑ Size:-Diameter------------------------ p --------------- --- \ Distance from nearest wel----------------------------------- ------------------------------- ----- ----- Distance from nearest building____._____,_--------- ..-,.. ----------------------- - ❑ Distance to nearest lot line- ----- -----------•-------------- - -- -- ----------- Remodeling and/ repairing �describe):_." _------ -- --- ----------------- ---------- - • ----- --- s s - ♦ ---------------- ... ! hereby certify that l have prepared this application and that the work one accordance accordance with San.Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. weer and/or Contractor) ----------------------------------------------------- - -------------------------------------------- -- -(O d I � - ------------------- Si ned (Titles —� ( 9 e]----- By:--- "` --------------•-_--- - � (Plot plan, showing size of lot, location rof system in.relation to wells, buildings, etc., can be placed on reve a side). FOR DEPARTMENT USE ONLY H -------- ---------------- DATE11 DATE_ - ----------- �' APPLICATION ACCEPTED BY------------------------------------------ --------'-- -----'------- --- ' - �--------- -- - - -- ----------------------- ----- - --------------------------------------------------- BUILDING - ---------- --------------- REVIEWEDBY.----------'= -------- ----- '-------'-- DAT -----------------••---•---- - BUILDING PERMIT ISSUE ------------=-- , Alterations and/or recommendations:-_-____ ---- ----------------------------------------------------- --------------- • ------------•-- -------------------------- ----- - c ---- ----------------------- d -------------------------------------------------- ------ ------ -- - � f -•------------------------ -------- ' -''"• ixt -------------------- - Date--.--- - - -- ' ' F1NAL INSPECTION BY;..__.� -------- SAN JOAQUIN LOCAL HEALTH DISTRICT $14 North Street 132 sycamore Street app West Oak Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California 2M Revised 1-57 F Revised s_!T,