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FOR OFFICE USE: /-------------------- - ---------- ------------/ =------- y -/ _ APPLICATION FOR SANITATION PERMIT Permit No. -.--.L_ � (Complete in Duplicate) r Date Issued -------- ------- '.__. This Permit Expires 1 Year From Date Issued lot — 1-50—IL Application is hereby macle to the San Joaquin Local Health District for a permit to construct and install the work herein describ d. This application is ma prnpliance with County Ordinance No. 549. JOB-AC DRESS AN LOCATION_. "�f l _1 � ---- J----- Ki-4 ------- ------------L------------------- Owner's Name----------------�--�+�J---`--i�O--U�-�-- -�A-��•------------- -- j Phone---...-----••-- --••-----------•--- Address 1 / C -------•------ :.;------------ R-o- 1 --- Contractor's Name -•-.- }- ��] .�� Phone...-...."-... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Y--- Number of bedrooms 2-- Number of bathsc->-"- Lot size e-.------ -- -------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water }able44:�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ (Sandy Loam ❑ Clay Loam ❑: Clay ❑_. Adobe ' lardpan ❑ Previous Application Made: (If yes,date------------------ -) Noew Construction: Yes [ 4 FHA/VA: Yes P,1go❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Q Septic T Distance from nearest well""�___ .."Distance from foundation"/"--__""-"" -. � �' - Material-- ---.C�-- ---�-�------- ---------- No. of compartments-------- Size-- -F-y0"",___Liquid depth .__Capacity_----- --""" Disposa eld: Distance from nearest well--- .____Distance from foundation--/ ----------- Distance to nearest lot line---471 -_.--" " _"""___"""Len th of each line-. _�""a__ -------Width of trench-.�-.y-"_�----------_--- Number of lines"-"-"_" � _" . g /� ,} .i d[ ` -------- otal length-- ---------- S Type of.filter material-1-Y z-.4-- . A'bepth of filter material-./ ~ �. , j / / eepage P } Distance to nearest well------4d.0./-Distance rom foundation---_-__- "--___.:Distance to nearest lot line-- _.______ J s --Linin material Diameter___. i\umber of pits_-_��: ;._- g p 1 Cesspool: ox I Distance from nearest well-----------------Distance from foundation_-".-- -'--..---*Lining material__._----_-_------------.-_-___..lss El Size: Diameter------ A -•----------------- Depth------------- ---------• --------------Liquid Capacity. -------------------- ga . Privy: Distance from nearest well-----.- ........-------------------Distance from nearest building----.------------------------ "----_.� ❑ Distance tonearestlo+line ----------------- -----------------------------I------ ------------------------------------------ ------------ -- ---------- r .--Remodeling and/or repairing (describe):-------- � ------------------------•-- ------------------ i ---.. .." i, ------------- ----------------.------.-.-_-". I hereby certify that I have prepared this application and that the wo"rk will be done in accordance with San Joaquin County ordinances, State laws, a es and regu a ' s f the San Joaquin Local Health District. (Signed)------------------ - --..".(Owner and/or Contractor] (�- ---- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY "" DATE r�-- �- /- - -� -- - REVIEWEDBY--------------------------------------------_ - -------- ----------- -- DATE----------------------------------------------------------- D� TE--------------- BUILDING PERMIT ISSUED---------------------------------- ------ ---------------------- . = - / ' "Alterations and/or recommendations:__-_ � �./ --- ----- `-.f.--- --- �' -- --------- ---------------------------------- --------- � -�--�-sok--------- •---------------------- ------------------- ---------------- ------ ----------------------------------------------- --------------------------- �i L y I 4r30OW90 " Date------------------------ FINAL INSPECTION BY: ----AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. k Street 124 Sycamore Street 205 West 9th Street I Stocklonr California Lodi,California Manteca,California Tracy,California t