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FOR OFFIC USE; Permit No. PERMIT ..1. - ...d APPLICATION FOR SANITATION ----- (Complete in Duplicated Date Issued --- -"--" ----"""-"""------------------ " ----------- This Permit Expires 1 Year From Date Issued construct and install the work herein described. Application is hereby made to the San Joaquin Local Health District for a permit to This application is made in compliance with County Ordinance No. 549. !s/jf`/T "1�" JOB ADDRESS AND LO�`C,,ATION----._---- -------------- Phone----------------------------•------ Owner's Name----------2& ------ .... / ---- - -------- ---•-------------------"---•--"--...... Address----------/-0f------ �..(�_ -•---• Phone---------------------- ------------ J ----Name �A artmenfi House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve. Residence JD—Apartment ___---.-.- _ Lot size .c.�x-1/a-----•-------•--------- Number of living units: _�_- Number of bedrooms .�-"- Number � baths hto Water Table �U-- ft. Water Supply: Public system [Community system ❑ Private ❑ p Cla Loam Clay ❑ Adobe 8--Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ SandyNew Const❑ructiony Yes E] No❑ FHA/VA: Yes ❑ No ❑ Previous Application Made: (if yes,date---- -------------) No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: - Distance from nearest well-----------------Distance from foundatioin-------------- --i-- depth Material.--- Capacity-__.--""---__-"""-"-- �l No. of compartments--------------------------Size----•---•---.--- q p• Dispo al Fiel Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- --------Len th oeach h line------------------------------Width of trench.-------------:---•------------•-- yNumber of lines gTotal length----------------•=------------------•---- Type of filter material-------------------------Depth of filter material----------------------- -Distance to nearest lot lune--------------- ------- Seepage Pi}: Distance to nearest well r'1�"z-fDistance from f ds Zie°nDiameter" . ""_-------- -Depth_.."_..-" --.--- Number of pits-------I--------------Linin material-'�a�-- --- y Cesspool: Distance from nearest well-----------------Distance from foundation----_--------------Lining material--_.- - gals. Deth---------=------------------------------------------Liquid Capacity-------------------------- 9 ❑ Size: Diameter----�;;--------------------------------- p - ---------------------Distance from nearest building-----------------------------•------ Privy: Distance afrom nearest well--------------------- ❑ Distance to nearest lot line------ --------------- -------------------•----- .�-- =--------------��------- C 1�f�Av Remodelin,9 and/or repairing (des ibe}:_..-_-_ "_ � '----_----- -- �� ) �x Z --- /y"��//J/ -[dt-----------" ----- ------------------------ I hereby certify that I have prepared this a lication and------------ that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatio o the S n Joaquin Local Health District. -_.---(Owner and/or Contractor) (Signed)-. ------- - - Title By:----------------•------------- -- - - ...- (Plot pian, showing size of lot, locati n o system in r ation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY �� DATE----------------- �`" � --- APPLICATION ACCEPTED BY------------ �. '� DATE-------------•--------••-------- - ----------------- REVIEWED BY ---------- ------------------------------------------------------------- BUILDING PERMIT ISSUED-----------------•----------------------------------------- --—---------•------------------- ------------------------------------------------------ Alterations and/or recommendations:------------ ---------------- ------ _-"--_----------------------- - --------------- ------ S -------- ------- ------- - G` FINAL INSPECTION BY--------- ---- ----_. ..l- 4, --------- Date_ ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Manteca,California Tracy,California Stockton,California Lodi,California EG-9 REV113ED 0-59"'Co'ZM &.60