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Permit No. <br />Date Issued 7-////6 V <br />APPLICATION FOR SANITATION PERMIT <br />t's7. <br />FOR OFFICE USE: <br />(Complete in Duplicate) <br />This Permit Expires 1 Year From Date Issuecg ee" <br />Distance from nearest well cro Distance from foundation /6 <br />Number of lines Length of each )ine.../0-7, <br />Type of filtermateria .41-f ... Depth of filter material. <br />Distance to nearest lot line..1( <br />Width of trench .2-4/ <br />Total length .1-4"27 ' <br />)1•1 <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549. <br />3 430 ,4J.re—e) 27 ° -1 S- <br />JOB ADDRESS AND LOCATION_ fl1 47,4 VAeM44'1 etrz.--rv-4 <br />^ • <br />Owner's Name....i.V./...rxh•rr Phone <br />Address- /51,34 <br /> <br />74-r‘ <br /> <br />Contractor's Name .0000-21-/.."-- Phone <br />Installation will serve: Residence [?0 Apartment House 0 Commercial 0 Trailer Cpurt 0 Motel 0 Other El <br />Number of living units: / Number of bedrooms . 3 Number of baths 4.. Lot size <br />Water Supply: Public system CI Community system 0 4rivate RI Depth to Water Table 74— ft. <br />Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam 0 Clay Loam 2 Clay 0 Adobe 0 Hardpan 12'0 <br />Previous Application Made: (If yes, date ) No 1Zi3 New Construction: Yes 4 No El FHA/VA: Yes LI No D <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank: <br />Disposal Field: <br />E1 <br />Distance from nearest well 5'0 <br />No. of compartments (9" <br />Distance frog foundation /e r Liquid depth Capacity 42-Q-6 <br />Seepage Pit: <br />Cesspool: <br />0 <br />Privy: <br />0 <br />Distance to nearest we/iL 'Distance from f <br />Number of pits Lining material. <br />Distance from nearest well Distance from <br />Size: Diameter Depth <br />Distance from nearest well <br />undation Distance to nearest lot line <br /> Size: Diameter. 3.3 <br />foundation Lining material <br /> Liquid Capacity gals.---.: <br />_ Distance from nearest building <br />Distance to nearest lot line <br />Remodeling and/or repairing (describe) - <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />(Signed) (Owner and/or Contractor) <br />By (Title) <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY. DATE -JO -6 r <br />REVIEWED BY DATE <br />BUILDING PERMIT ISSUED DATE <br />Alterations and/or recommendations: <br />FINAL INSPECTION BY: Date. -s---ei <br /> <br />SAN SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> <br />1601 E. Flaselton Ave. 300 West Oak Street <br />124 Sycamore Street <br />205 West 9111 Street <br /> <br />Stockton, California <br /> Loth, California Manteca, California <br />Tracy, California <br />LS 9 REVIEMIE1-59 310 3-'63