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rUK Urrll...t U:Jt: APPLICATION FOR SANITATION PERMIT (Complete'in Duplicate) This Permit Expires 1 Year From Date Issued Permit No.il-..,;?..J'..Ic;:!.~ Date Issued ..£!~..!r-:.~7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No.549.f ,. JOB ADDRESS AND ~OS:ATION····7.~I.)··!······:£······/~·U!.i.7 ..2.t ~~.L ~~~!.~/J . Owner's N:;e~;..(;;IlFP-l<..d~~~.~~.(.ii.?lt:l/:lti~(i;.Phone.2.3I~..&.;;..7/...~~~:~::;~;::~:,s:ff.~~'~~u~~!-'!Ph~O: Installation will serve:Residence jg Apartment House 0 Commercial 0 Treiler Court 0 Motel 0 Other 0 Number of living units:.../...Number of bedrooms ../..Number of baths ..--t ..Lot size .A ./1r.e~5'.~. Water Supply:Public system 0 Community system 0 PrivatejO Depth to Water Table 'If ..ft Character of soil to a depth of 3 feet·Sand 0 Gravel 0 Sandy Loam l&l Clay Loam 0 Clay 0 Adobe 0 Hardpan 0 Previous Application Made:(If yes,date..............)No)(I New Construction:Yes 0 No 0 FHA/VA:Yes 0 No R1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan~:Distance from nearest well.iOP.'..Distance from foundation 3.9 Material C.OII/.<;.&.~.f:.~. ~~\s\i,•..i6 No.of compartments h..Size q.~..n..g Liquid depth...4·~·.!Capacityib.a·7·4'/'. Disposal Field:Distance from nearest well ./~q..~..Distance from foundation ;e...~Distance to nearest lot line ,?~..~:. I2l ¥i;~+/N(r Number of lines I {J :--.~~Length of each line ..R.P Width of trench .??~..~~...................'" Type of filter material.~.c..k-..~Depth of filter materiel.?~Total length i'o.~.............................\'~ Seepage Pit:Distance to nearest well..;Distance from foundation Distance to nearest lot line .o Number of pits.__.Lining materia!..Size:Diameter Depth . Cesspool:~istanc.e from near.est well Distance from foundation __L.ini~g materi~'-__~o Size:Diameter.____Depth Liquid Cepeci+y gal~~ Privy:Distance from nearest well..__..__Distance from nearest building..........................................'\o Distance to nearest lot line __. Remodeling and~or repairing (describe):..Ch.r()./JI.~.C.tr jl4:&J/.()§:~~!I.Il-/!I..<7P C,O.;.lt.~~'i.;. ..~~P-::tfc-·······t··~·::t.~@~p;i·v.-··f/.I&I-e.&.·f)f··--·I.:~·..Z'-,,·lj?A:.:..c{ai.,..':fA j.;~rT·-!t.·i-:·7f:~·&k.S . .....:i1.f.\.(.r:...I.~!!.J.J.".(tr..~d !'~.:1:.6.(·.~;p.t~.'!.I£d-.(l-:.r:.!'..:'Y.$'~.~:~~!.\/.t(.~.~~t'Jr!1·!!'·!7··~·.··-/.!y;,S~l?--~:f'-~. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,State laws,and rules and regulations of the San Joaquin Local Health District. ISi9Md~~==~~-r;{~±'•••••••••••••••.••••..•••.•••...••..•..·..:••..·....I~itl~)..·..•·...IOw0er "d/0,C~ot'.cto,) (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=pa' ~::I~~~~I~~..~~~~~~.E~..~.~:~=:::~~~:~~~rf..:::::~:::::::::::::::::.::::::::::::::g~i~::.:::!:~~:~~~:?::::::::::::::::::::::::::: BUILDING PERMIT ISSUED _DATE . Alterations and/or recommendations:. I FINAL INSPECTION BY~.72C&..<~~.....Date ...:/y ...2-:·~..~.q..l---.· _/-~/~/T "--,." SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha ••lton Ave.300 West Oak Street Lodi California 124 Sycamore Street Manteca,California 205 West 9th Street SJockton,California E_'--I,9 2M 1·67 Vanguard Press Tracy,California