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FOR OFFICE USE- Y3 ......................................................... APPLICATION FOR SANITATION Paw Permit No. 1 ...31,i-1 f/ ......................................-------------•---- (Complete In Dupliooto( •-•-•---------------------------------•• ................ This Pormit Exoiros 1 Year From Data Imuod bete Issued ..f_.zP /4_S,'_ Application is hereby,made to the San Joaquin Local Health District for a permit to construct and,install the work herein d bed. This application is made in compliance with County Ordinance N . 549. W i JOB ADDRESS AND O�C'ATIQN-. _t......._.----•---.•....... Phone �� %f qOwner's Name......... ;.....14j � L .'....•.... _. Contractor's Names Phone---'�e.Z a...... ..---. .. ..............•........._..--- ......................-_... Installation will serve: Residence RKApartment House ❑ Commercial ❑ Tr;�_Lot rt ❑ Metol ❑ Other ❑ Number of Living units: _.�__ Number of bedrooms..,-3 . Number baths _ size _. -� ! _ ------- Water Supply: Public system ❑ Community system ❑ Private {Depth to Water Table -------- ft. �_ - Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam LClay Loam❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,dote............:____...) No ❑ New Construction: Yes ❑ No ❑ FHA/VA:Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No %optic tank or cosspool permitted if public sower is available within 200 feet.) - Septic Tank: Distance from nearest well.................Distance from foundation-----------........Material•-_-__--_--_•--._•------.•----•-•-_------. ❑ No. of compartments...._-_..........._-----Size---_------------------------Liquid depth--_—-----------_capacity-------- R. If Disposcil�Field- Distance from nearest well...a5iO__...Distance from foundation------,f 4'_....._Distance to nearest lot line--S....._. Number of lines.._.___/-------------------Length of each line------------- .Width of Type of filter material...... Ir..__._Depth of filter material-------- length--._. Distance to ttiedrest well.._.., __.Distance from foundation..-_-/4'....Distance to nearest lot line..-.... �... ❑ Numbet of pits._...._../..._..--Lining material_,,�a�--•___Size: Owacx�?er_.r�_-v _ `Depth-----.1�f................ g Cesspool: Distance from nearest well----------------Distance from foundation.______.-__--_.Lining material--------------------_--_----------_. ❑ Size: Diameter........ ---------__._Depth..--__--------------------------------------.Liquid Capacity-.....-_.........._ -gals. g Privy: Distance from nearest well.................................................Distance from nearest building......................................... ❑ Distance to nearest-totline-----------____....-.......................•---------------_-----.-._--....--................................................... Remodelingand/or repairing (describe):.........._...................................................._...........-----____.__---._____..-__..___------.-......... _.._._._... . -•--------------------------- --.___ ._ _---------- ....____----------•------_.__•-------___-- 1 hereby certify that i have prepared this application and that the work wig be done in accordance with San Joaquin County ordinances. State la a rules and regulations of t e San Joaquin Local Health District. (Signed)-----•-•-...---•- ------------ ----•-•-•-�...- Id... . ........ .....------------------------------- _-__..._. - (Griner a Contractor) actor By:..._.._...- � -_. L..._ ._ . ---------- ---------------(r�� :.�................� =-•-----............._._....__... (Plot plan. Blowing size of lot,location of systom in relation to wol buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- _-•--•------- DATE--_I-:-Al...;_.__--4J.........._.................. REVIEWEDBY -------_----------- -----------------------------.........................._.............___-..----------- DATE.........._......-------------------------------------- BUILDINGPERMIT ISSUED----------------•------- .-..............-......W....... - DATE-----------------------------------------------_------- Altarations and/or rowmmondations ----------------------------------_----__--------._-__---.._._..—_� -_____---•---------------- ---------._.__-_____.... .-•..................................•--------•--------••---•---------.._....---------•-•--......-•--•---------.....----................................................... - ......................_......----------------------------------------- .................................................................._....................... ------•••..••... � -------------•--------•-------•---------- FINAL INSPECTION BY:_�r.+,L��.'�+!� ...-•----•----....... Date---- -------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT -' 1601 Q.Haionaa Ave. 300 West Oak Street 124 Sycamore Street 203 Wast 9th sheet 516drten,ealfforala Lodi,California Manteca,California Tracy,Catifornfa [a 0 06V196D a-ss 2M 2-169 r.P.C6.