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APPLICATION FOR SANITATION PERMIT Permit No. .-J_2.3-f- \ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ---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. JOB ADDRESS AND LOCATION----------------VI- MI—00 --- ARS'.`------------lot -- ---`�I ---------------- .r _ Owner's Name-------------- x_'/3049*---4M0ly----- t •-----•-------- Phone 4 ` --- ----------- Confirar_tor's Name _. - ---------------------- --------------------- -------------- - ----•----- Phone--- +$t_. ----- Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---'-- Number of bedrooms ------3Number of baths J---- Lot size "_" -_ _- -•""" Water Supply: Public system ❑ Community system [I Private ❑ Depth to Water Table:-"49 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [it Hardpan ❑ Previous Application Made: Yes3R No [9 New Construction: Yes 91 No ❑ FHA/VA: Yeses No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or•'cesspool permitted if public sewer is available within 200 feet.) Sd Tank: Distance from nearest well__4 "_: Dist fr m4 undation ��_-._.--_-_--M t,Vr'rai--- 14'� 3"la No. of compartments-------------- ------------Size------------------------ -------------------------- -- - Liquid depth_ -- --------------Capacity- -- ------- Disposal Field: Distance from nearest well__AA------Distance from foundation_3,641 ____-_"Distance to nearest lot line.....V 4 Number of lines--- '--------------------------Length of each line------- ---------------Width of trench-_. _ -_-- 1 YP 4#1 p s ----------------- T e of filter material ""_".__"_ __---_-De th of filter materialip----------------- length ---------------------- See pyTge Pit: Distance to nearest well____k*" ------Distance from foundation-_ _ ---------Distave to nearest lot ine_ *"-_"""_..- 42 �► Numbe of pits--------==------------Lining material__�' i -------.Size: Diameter------- ._.-. ""--Depth--9. ..________-___._-"-""-. Cesspool: Distance from nearest well----------------- from foundafion-----------------_Lining material---------------" (" Ej Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid.Capacity--- -----------------------gals. Privy: Distance from nearest wellEl _".___ --------------- Distance from nearest building-_-----.__--- --- Distance to nearest lot line._.__.."- --------------------------------_______" • ----------------------- ----------- Remodeling and/or repairing (describe):--------------------- ------------------- ------------------------------------------------------------- ----- - - 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. (Signed)- ----- --------•--- 9 It IGARVI ------------------- Owner and/or onoF) o B)'---• -- y ! -------(Title)---------------------------- - -- - -------- --- ---- -- (Pl of plan, s owing size of , locati n of s stem in relation to wells, bu s, etc., can.6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - DATE--------- ��-=--1 ci_"_""-"--- ----------- ---------------- REVIEWED BY------------------------ DATE ---------------------------------------------- ----------------------------------------------- -------------- UILDING PERMIT ISSUED. --------------------------- DATE_ Alterations and/or recommendations:-------.- --- ----- - ----- --------------------------------- ------------------- --------------------------------------------------- -----•------------- ------------------- ------ / --------------------------------------------------------------------------------------------------------------------------- -- --- ----- ------ FINAL INSPECTION BY:------ ----- _ ----- Date------ c ---------- ---------- SAN -------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ' 300 West Oak Street 132 Sycamore Street 814 North Stockton, California Lodi, California Manteca, California Tracy, • lifo ' w _ E5-9-2M Revised S-'S9 F.P.Co. Vin.