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FOR OFFICE US • y APPLICATION FOR SANITATION PERMIT -- --- ----------- (Complete in Duplicate) / / ---- ------- - Date Issued -----/-I-�l--6/ --------------------------------------------------------- ------------ --------------- --- ----------- --- This Permit Expires 1 Year From Date Issued A lication is hereby made to the San Joaquin Local Health District for a permit to c rust and in stall work herein described. all t pp This application is made in compliance with County Ordinancoli549. G -- -- --- ---- - ------- ---•-- -•------........ ,106 ADDRESS ANBD L AT10N--------- ----- - - --� -----. -- - - - - ____...__ _ r Phone., Owner's Name_ Address----------- Phone.. Contractor's Name-----------------•----••-- - - - - - "- - Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ motel ❑ Other C1 -•--•�Number of baths _/__ Lot size _-- ---. ZC.61--•-------•-------- Number of living units: _-{__ Number of bedrooms __i ! Community system ❑ Private [s�epth to Water Table�V ft. Water Supply: Public system ❑ Y Y a Adobe Hardpan C][I ❑ Clay Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam Clay Loam ❑ ❑ Previous Application Made: {lf yes,date--------------------f No ❑ New Construction: Yes ❑ No [E,/FHA/VA. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e is ank:. Distance from nearest well_________________Distance from foundatiLiquid n--------de th Material____:----_Capacity____.""__-___.________ No. of compartments---------- ---------------Size---------------- q os ie d: Distance from nearest well--__----____.:_Distance from foundation__________________•-Wks}�ofto nearest lot line.-_.----_----:-- Length of each line------------------------------ Number of lines--------------------------------- g - - ------------- 4PType of filter material________________________Depth of filter material___._--__._____-�-----Total length-------------------------- Distance ----.-----.------ ---- --- i Seepage Pi}; Distance to nearest well_-_ -----------Distanc om undation__ Q.......__..D'sstance to nearest lot line___. ---Linin material_ _ ::_ -Size: Diameter_/PY_l _"-----.Depth-------�---------- �I ❑° y�D Number of pits ------ ------- 9 Cesspool: Distance from nearest well----------- from foundation-___________-.___-.Lining material-___-___________________ -els. ❑ Size: Diameter-------------------------------------- Depth -Liquid Capacity---------•-----------------9 ' Distance from nearest building------------------------------------------ Privy: Distance from nearest well________________________:- -------------------- ---------------------------------- Distance to nearest lot ine"--------------------------- - - Remodeling and/or repairing (describe)----------------------------- i ----------------- ------------------------------------------- ----- -r--- --------------- ---- - ---------------------------------------------------------•------- 4 hereby ertif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5 a laws, and cul and gulations of the San Joaquin Local Health District. caner and/or Contractor Si ned _ -- --- --- Title ----- (Signed) ---- By:----------------------------------------- ----------- ---------- (Plot plan, showing size of lot, location of system i relation to wells uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE 6NLY ^--`-------------------------------- DATE----------- APPLICATION ACCEPTED BY-_ - ----- DATE------------------------------------------------------------ REVIEWEDBY--------------------------------------------- --------------------- BUILDING PERMIT ISSUED------------------------- -------- DATE. -- ------------------------- Alterations and/or recommendations------------------------------------------ ------------------------ ------- r ._. _. - " - ----------��`-``--- ----- ��c r L9-e .a � yet — ---- __T- --------- --- ------------ - - FINAL INSPECTION BY--- ------------' �J Date----- ~` . SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street 130 South American Street Lodi,California Manteca,California Tracy,California Stockton,California EB-9 REYIBED 8.59 F.P.CO.3M 6.60