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FOR OFFICE USE: APPLICATION FOR SANITATION PERMrr Permit No. .� <..._.r_...��. (Complete in Duplicate) Date Issued -�'---- - This Permit Expires 1 Year From Date Issued plication is hereby made to the San Joaquin Local Health District for a permit to�c�o�stru and install the work herein described. t/r Tn's application is made in compliance with County Ordinance No. 54� ;OB ADDRESS AND ION..--- ....... i Phone. Owner's Name-.........• G �' > � - 3 Address...................... - -----� ---- - — _ c� i Lam-G �s�,�- �. --- Phone_ -�•� `J� r� Contractors Name...... ........-�9��-�--'-�- �- Installation will serve: Residence [2' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ c.� l�4. '.F ... �_._ Number of baths _I.,,�i�Lot size _. _:_. _. . Number of living units: -_�.-_ Number of bedrooms e ft. �6 Private /�- Water Supply: Public system ❑ Community system ❑ ❑ Depth to Water Tab Character of soil to a depth of 3 feet: Sand ❑ Gravel [) Sandy Loam X Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date- _. - -- No New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No fir] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) No. 'of compartments....... - Size Liquid depth------------- Ca Septic Tank: Distance from nearest well_..__..-_._..__Distance from foundation----_-------------Materia --- pati tY----.. ❑ 1 "f each line.__!c`� �/-----Width of trent rest lot line__ 5.- ----- Disposal Field: Distance4rom nearest well. .:Destan��ceofrom foundation-/_0 D stancentohne h � Number CIT fines ---- g urs ...... De th of filter mater al___./4g _--..---Total leg -.l Type o4 filter material.J ,��G ..- P Seepage Pit: Distance'to.nearest well----------------------Distance from foundation--------------------Distance to nearest lot ine..._-.___-_-__-. may., Linin material - Size: Diameter.......................Depth..---- ❑ Numbe# oT+p4s:'_.. g 1 Cesspool: Asf�j from nearCst well________________ Distance from foundation...._._.___..__.._..Lining tlnateria ._.._................................als. - De Depth Liquid Capacity---•----------------•...----9 ❑ Size: Diameter- ------E------- --------- - P Distanceffrom near est well_______________________________________'__...__.Distance from nearest building_._-__.-__-__-_--_-__-_____.___.......... . Privy: j3C ❑ Distange to nearest roTne Remodeling and/or repairing (describe)------- ----- - ----------------------------------------------............................... ----------- ---------- --- -= t----------------••--•------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and regulations oft San Joaquin Loctal Health District. - ---.-----...... (O net nd/or Contractor . (Signed) - . S! i -� G f!L - - (Title) BY - p (Plot plan, showing size of lot, locati system in relation to wells, buildings, etc., can be. laced on reverse side). FOR DEPARTMENT USE ONLY -� ��. DIATE APPLICATION ACCEPTED BY----- D'ATE_..__ R EV I EW ED BY --- ---•---------- DATE- BUILDING PERMIT ISSUED------------------------- ----------------- ------ Alter ations•and/er►recemmenda+ionsr---..-^---- ''�'T'. -•--------••-•-- . ........................................................-........... FINAL INSPECTION BY:...." --------- ......- . Date....... ___...._. ................................... SAN JOAQUIN LCCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1601 E. Hazelton Aye. Manteca. California Tracy, California Stockton, California Lodi, California