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.......... ..................... _+OR'SANITATION PERMIT APPLICATION Perm- if No. .../,F .... .. ...... ...... .............................................. (Complete in Duplicate) ------- This Permit Expires I Year From Da.toAssued Date Issued ........... 'Application is hereby.r6de to the San Joaquin Local I Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. Z67-od40-py ....................... JOB ADDRESS AND LOCATION..y4^%,L.A"* ei't---alyr�... .....---------_ ................ Phone. Owner's Name..-------- - --- --- Addres&............... ............. ........ ___`x.119..._..------------- ------ ....4-F.... Contractor's Name......ITA. 6L lent Comma 171 TrailerCourt [] Motel [] Other [3 Installation will serve: 'Residiin.. Apartment House [] Comme Number of living units:,.:.!'.. Number of bedrooms ...1,Number of baths .....'... Lot size ....... , 9 ..................... Water Supply: Public system.El tCor.nmurti� system ❑ Private Cg'* Depth to Water Table 16- ft. Character of sail to a depth of 3 feet: Sand [3, Grovel N/S cly Loam 0 Clay Loam 0 Clay El Adobe 0 Hardpan 0 Previous Application Made: (If yes,date...........*........) No �7New Construction: Yes, ❑ FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS:— (No septic tank'or cesspool permitted if"public sewer is.available within 200 feet.) Septic T nk: Distance from nearest well-!..4 ......10 f r jaflLo,n_, aterial-----en�,.e� M' ...............div 1z P;110 No, of compartments..........2�---------- Liquid th......Y...T------------Capacity... J Disposefield: Distance from nearest well................Distance fromqoundation..... ....Distance to nearest lot line.. Number of lines Length of each line.........t7k!_............Width -of-trench .. ...f..............-...... Type of filter materials !'-XD-epth offilter material....U.'!I........Total length...........7.A:........................ Se Pit: Distance to nea.e., we�ll_il ..........Distance from 4punclation....j ......f'__Distanc? to nearest lot line..0&%^ ------------7 Number of pits___.-.:_.--__..__._--Lining material_..jL_#C-1<__S;Ze: r---LIXJ.�,_---_Depth.....:11.................... Cesspool: Distance from nearest well....-::-.......Distance from foundation...................Lining material---......................... Size: Diameter- 0 ...... .... ................_4Depth...:........ -- - - - Liquid Capacity----------------------------gals!,,,-; Privy: Distance from nearest well............... ..............................Distance from nearest.building.......................................❑ r Distanceto nearest lot line...:..-..)...........1..................... ........................................................................................ N Remodeling and/or repairing (describe):.......................... .............»........=---------------------•-.....7........................................................ ......................................................................................................... ............. ............................................................................ .................................................................. ................................................................................1._.1------------------------------------------- .........................................-—-------........................................................................................................................... -- --- -- 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 end 4re SSp ulations of the / , Joaquin Local Health District. ..... ..... (Signed)............ ... 4 - ..................w....................... .............................(Owner and/or Contractor) By:.-- .........__------ ...........................................6.......................................... ....(Title)_...................- - ----------------- ......... (Plot plan, showing size of-lo+, location of system in relation to wells, buildings, efc., can be.placed on reverse side). FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY---------_615_7--- ------- --....... ..........»......._........---------- .......................... REVIEWEDBY_.......................-------_----__----------------- ....................................................... DATE.............-----•--•.. BUILDINGPERMIT ISSUED..............•---'•---------......--......------...... .................................... DATE.............._................................... Alterations and/or recommendations:......................................................................................................................................................... .............................. .......................................--.._-..••.......•-----............................................................... ............................................ ....................................... ......................................................................................I......................................................................... ............................................................ ..................................................................................... ............................................................. ................ .............-------...................................................................;.............. ....................................................................................... FINAL INSPECTION ..................... Date...... ............................ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelter,Ave. 300 West Oak street 124 sycamore Street 205 W..1 9th Street St961.,C011forriia Lodi,California Manteca,Calif.r.l. Tracy,California a-59 2. r.p.co.