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- -- �-- ---- ----- -----�__....�_-. _.---------- -._�-..__----._-.---- � APPLICATION FOR SANITATION . __ .._-. PERMIT - ----- - Permit No. f _ _ (Complete- Duplica}e) This Permit Ex i►es 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for This application is made in co Date Issued ��'---_�D--�� mpliance with County Ordinance No. 549• a permit to construct and install the work herein descried. JOB ADDRESS AN LOCATIO `,;�� ' Owner's �� Name__ " ,_ Addr - ------- ess_ ------- Contractor's Name_ Ph _ :. pa�� - - , Installation will serve: Residence ®I Ap6rtment House = Phone Cr Number of livingunits: - tr �'� "---? ,,, [� Commercial ❑ Trailer Court f---- Number of bedrooms ❑ Motel El Other Water Supply; Public systemCommunityI D ® system III Lot size •�G�_ Character of soil to a depth of 3 feet ❑ Private u Number o aths,._---__ ❑ Depth f6 WateJ11r Table ft t Previous Application Made: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam TYPE OF INSTALLATION AND SPECIFIC--- ___ ❑ Clay Adobe = l NO � New Construction; Yes ❑ Hardpan ❑ (No septic tank or cesspool permittill (IONS: ❑ No FHA/VA: Yes ❑ NO'N Septic Tank: J y pug seweravailable within 200 feet.) Distance from nearest well_-___-_-__- -_Distance from foun�. ❑ No. of compartments-.---------- Size- ---.._.Material Disposal Field: - -------Liquid depth -----, Distance from nearest�well____�--- W Number of lines-__--- t.. � ----- --------Capacity--------- ----Distance from foundation".�1Q,`_--- _ --- rte., ----Distance to nearest lot line--_!"�: Pit: Yp of filter material_ ¢-�� -- Length filterhmrate ___ - -- Widtp of trench_--Z. �r Seepage -.Depth R ; - ----------------•- Distance to nearest well;--_-.-_ gyral Distanlce #length--_ �f ❑ plumber °f pits._.----___-�� ----- - ------Lining material----- 5ize;TD t--------- Cesspool: Distance from foundation-_- o neatest lot line.__---_--- _ Distance from nearest weft----- rameter_-•-------- - --------Depth.... -------- ❑ Size: Diameter_ _- Distance from foundtio --- ---.Depth--.------ Lining material- -----Privy: Distance {tom nearest well -- -------Li uid - ❑ q Capacity. ------gals. Distance to nearest lot line -- -------------- ------- --Dist�ce from nearest buildin Remodeling and/or_repair-ing„(descr-ib_e.); -- - 4 - --------- ,�: {l------------------•-- - - ------------ - - - ------- --------- ----------------- ------------------------ i ordinances State aws.and lrules and re ula ions of the $a } hereby �., a ppal V1 - nd that the wo�.k�will be done in`accordanc-- with San Joaquin Count g n Joaquin Locar!`f iealth District.I '.(Signed • t y By: I� ✓- -------- - c.._ t ----(Owner and/or Contractor) bt plan, showing size of lot, location of system in relation to wells, buildings, etc., can be I Title ( ) � I paced on reverse side). FOR DEPARTMENT USE ONLY ATION ACIIEPTED`8Y"" ""'"'" -- i _;ED BY 1 -- - - - - ------------------------•----------- --------- PERMIT ISSUED -- ATE- ------- ----- �.�.. --- -------- --- ------ {' DATE-- ----- ._,and/or recommendafions:---_-- 1- ---- -- - DATE --------- ------ : :"�:a._.__� -----------------q - a_----_-::--------^ _...._ ----------- --------------------------- ----------------------------- 141 - . . - . M► fr , Y w, r --------- - DN BY: '- -------- Date---- ' 3-"m- ---------- ___--- SAN JOAQUIN LOCALHEALTH DISTRICT --------------- 1ve. 4 = 300"Ill Oak Street ' Lodi, California 124 SYCamore Street Manteca, 305 west 9th Street California Tracy,California