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P�e 411 A' APPLICATION FOR SANITATION PERMIT Permit No....... ...°... ` (Complete-in'Dupl4catej A - - ,�.,.' � - � �� ,� Date Issued .----•- --.._ This Permit Expires'l Year Fro Date Issued i Application. is hereby made to the -San Joaquin Local Healfh District for a permit to construct and in the work herein described. This application is made in compliance with County Ordinance No. 549. r /-------------•------------ JOB ADDRESS AND LOC TION'G- Z --- - Phone-._-- --- - ---------- ------------ '-----------------------o•-�-- i Owners Name----- -�. Address------ - --Phone- - --f " = Contractor's Name Installation will serve: Residence it Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: _-�_-- Number of bedrooms ._2-.- Number of baths_ --- Lot size ___ __ ____ _____ Q - - �_� ----- '_. '! Water Supply: Public system V'r Community system ❑ Private ❑ Depth to Water Table `�.� ft. 3 Adobe Hardpan Character of soil to a depth of 3 feet: Sand ❑1 Gravel �] Sandy Loam ❑ Claiy Loam ❑ Clay ❑ ❑ Previous Application Made: Yes ❑ No En- New Construction., Yes ❑ No E" FHA/VA: Yes ❑ No R9 - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 'UML -------Distance from foundation_-_ ---------- Matecial------------------------------------------- Septic Tank: Distance from s - nearest wel4---Liquid depth-------------- -------- Capacity No. of compartments- - Size. = __-- �. �__ ' lI" Disposal Field: Distance from nearest well-Distanee from fouridafior%-=".._._ _"Distance to nearest lot line-.-___ - _ nth of each line ---------- of trench. - Number of lines---.- _-_•-- 9 -- Q Type of filter materia (!.-- ----- epth of filter !material ---I .--------- To#al length------ ------ --------------- Num I 1 / Seepage Pit: Distance to9nearest we4l._---.�r��-------- Distance from foundation_-_.l-_n_-_.___.Disf nce to nearest lot lie_. ---ti_._ L ' r >-_-Linin materia ¢e: Diameter'3i':`�d}Depth l -❑ Number of pits-------- - g } p well------------ --- "Dlst�nce from foundation -------------_-----.Lining �,m'aterial-___._-.-._----� °-'------------------ Cesspool: ------------ Cess ool: Distance from nearest -Depth_` _------------------------------------LiquidC'apacity.---------------------------gals. Size: Diameter-------------------------.---- ---- �, ❑ : ' Privy: Distance from nearest well "_.-..".---.+__--:-:---=---_--`*'dEstance`fFom nearest building.--""_--- _---------------- %` -' . L � ❑ --- -------------------------------------------f' 1; Distance to nearest lot line --------- ------------------------------- _ T-------------------------------------- -----, ; -._-_-.--____-----___------ Remodeling and/or repairing (describe)------------------------'-------- -------•-----------• I---------- =' ------------------------------------------------------------------------------------------•------------------------- ` ------ 1\-- --- �`- ='------------------------------- •---------------------------------------•--------------- - --`-------------------------------- ' I hereby certify that I have prepared this application and that the�wo�k will�e done in accordance with San Joaquin County ordinances, Stat laws, and rules and re tions of t an Joaquin Local Health District. caner n Contractor (Signed)-- L' ------------------ ----------------------------- ------------------------------------ r(T�tl- ye-% By:-: 2%.e tr � . .............. (Plot plan, s owing size o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY C c' ---------------------------- APPLICATION'ACCEPTED BY -- .--------------- ----------------------- ------- - A REVIEWED BY_;; ----------- ,; -•---------------------------- DAT E------------------ -------- ------------------------------- ISSUED --------------------------- ISSUED ---------------------BUILDING PERMIT Alterations and/or recommendations ------- -------------------------------------------------------------- - _- ---•--------------------------- -------------------------- [/} ••_-•--------------•------------__-•---__•---_-•-----------•-------------"----- ate!�`� r� ----- FINAL INSPECTION BY:---------- - ------------------- - -- " -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30o Well Ciak Street 132 Sycamore Street 814 North "C" Street 'Lodi, California Manteca, California Tracy, California Stock+on, California E5 -9--2M Revised 8-'59 F.p,Co'