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FOR OFFICE USE: APPLICATION FOR SANITATION PFRMIT Permit No. /..lG.....`.K . ...................•......... ...... (Complete in Duplicate) ., — i, Date Issued Z1:: ...r..'� .� .•.. ..... _ Th's Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. TI.is application is made in complir,r•ce w•• Coun v Or mance No. 549. 7d� s7VZ� t. JOB ,DORESS A LCC ION....... _..... L�C�i!` .�....... .... . . wE ... ..�......... .. n. ... Owner's Name...... _�. t t.f . .......... Phone................................. Address.................... .. . . . .. ..+... ........... ...................... . ..... . ........ ........--......... ......... .. ........... Contractor's Name...........-.........L X14�s�dr/C ..... ..... ..... A--el Phory Installation will serve: Residenca ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: . ..... Number of bedrooms ........ Number of baths ........ Lot size ..pC.. •........................•••••• T Wwtnr Supply: Public system`, Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe 4 Hardpan❑ Previous Application Made: (If yes,date . _ _. .. ) No New Construction: Yes ❑ No 0— FHA/VA: Yes ❑ No)< TYPE OF INSTALLATION AND SPECIFICATIONS: y (No septic tank or cesspool permitted if p ��u,blic sewer is available within 200 feet.) ,-� Septic Tank: Distance from nearest weIIjt ..�-Distance from foundation...lD......MateriallF(%¢4�1`-.... 4 ym T-'- No. of compartments...1-,. . ..........Size. .X..�... ............Liquid de th.�..�..NNN.///........ Capeu}y .... Disposal Field: Distance from nearest well 0A)G77.Distance from foundation-Al-.Q.1......Distance to newest lot line........s..�.. n Number of lines 1. .Length.l.FLen th of each line.. Width of trench.7i¢�......................e� 9 r........... Type of filter material..,® 1�.Depth of filter material... ............Total length.......tQ-0.......................... O Seejpaage Pit: Distance to nearest well.�t(;l✓......Distance froi foundation-OZ7........Distance to nearest lot line................. 1 T` u Number.of pits..Q'Y(C�.. ..Lining material. kI .... Size: Diameter.... tr `' �.�. ........Cep,n...,i-..�`................... Cesspool: Distance from nearest well................Distance from foundation................. .Lining maitrial.....................................•5 ❑ Size: Diameter... ...................__.......Depth............... .................................Liquid Capacity............... ...........gals. "v Privy: Distance from nearest well.......................................... ... .Distance from nearest building...............:.......................... ❑ Distance to nearest lot line. ... .. . ... __...................... ...............•---••-•------................................................................ ,I Remodeling and/or repairing (describe):........ _ _. ................................................................... .............................. ..............I.............................. .................................................................................------............._.................................... I hereby certify that I have prepared this app' ation and that the work wi. be done in accordance with San Joaquin County ordinances, Staie laws, and r les nd regulations of tho ;an Jo twin Local alth District. ' A wrier and/or Contractor) (Signed)......... (O -......•.'� s (.. ..... c....... ...........(Title)...... . ..........._ (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc.. can he plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... .. .. ..1'L .. sem"' - ............... DATE........ ./.. ..... .............. REVIEWEDBY.... ................ .. ..... .... ............................ DATE............................. ............................ BUILDING PERMIT ISSUED....................... � _................... ..... ,.... DATE............, ~........I. !.......................... � .r Alterations and/or recommendations:.......t .. �- .... ................................. ............................................................................. _. ...... ..._.... ._ ...... .. ...._....................................... ............................... .. ... ...... ___ .... ... .... .................._............ ............... ..................... . / �� / f l << Date / Z:/. _ _. .......................... FINAL INSPECTION: BY:. .. � " SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Matelton Are. 300 Weft Oak Street 124 Sycamore Sheet 205 West still Street Stockton,California Lodi"California Manteca,Colifornio Tracy,California P CO.