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FOR OFFIC5 USS: 1 -- ------------ APPLICATION FOR .SANITATION PERMIT Permit No. ------------------ 2 iGA (-(YL - (Complete in Duplicate) Date Issued ---. --. --•- ----- This 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. This application is made in compliance with County Ordinance No. 549. OB ADDRESS AN L C ION Phone ---- -- ------ s Name -- �---- Owner r __-42P.-------fir ------- ------------------------- - Address , one------------------------------------ • - ---•----------•---•----•-------------------------------------------------------- Contractor's Name.------- •----- - -- -------- - - Installation will serve: Residence ®�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ X-��.. ------------------------ k Number of living units, __/_-_ Number of bedrooms _--___._ Number of baths - -.__.. Lot size _- -- Water Supply: Public-systern:Community system ❑ Private ❑ Depth to Water Table J/1P ft. Character of sol! toa depth of 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ . Clay ❑ Adobe Yes Hfard�No C3Previous Application Made: (If yes,date---_ , -�- ) No F1 New Construction: Yes [ No F] FHA/VA. L TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) dr !a • 4 ----- ------------------- Se tic l ti� _ . Distance from nearest well-._---- Distance from foundation_-.-_��---..--.Mate�n�----.------�s---.---- Dp � ----.---- // p � No: of compartments------�---------------Size-v5_!F-�.--��------Liquid depth----�.u------------Capacity.. -.------ - ' .- y Z49 Disposal Field: Distance from#nearest well----I-----Distance from foundation.___.---- ..-.Disfahce to nearest log line..+S--_-- --- �___ _____---Width of trench---- Number of lines-------- Length of each fine--- rJ--- i� 1 Type ------- Number filter material,l fjG Depth of filter material-_-_/f-_._--------Total length------ �----•--------------------r--- �Q -_--.Distance to nearest lot lin e--. -~--. S � Seepage i Distance to nearest well.-.-----_-'"-:-__--Distance from foundation---.___.- .--Linin, mDepth-_ --- ------ l- -pP.� Size: Diaeter_ ------ ' Number of pits-.----�------�-- -- g materia �- ---- ---.- l Cesspool Distance from nearest well-_--------------Distance from foundation-------------- material----------------------- -----Depth----------------- -------------- Liquid. Capacity- 9 A ❑ - Diameter-------------- ----------- Size: ------- --------------------Distance from nearest building--,--------------------•----•------------' Privy: Distance from nearest well---------------k------ _ -- t ❑ Distance to nea- t lot line------------------------------------ ----- : . -4 - Remodeling and/or repairing (des i6e)�-------- . i --------------.--- •----------------------------------------- -- u r r _ -` ------------------------- ---- ---'-'-- '-- -:-----�i'^--•---------------••------------•---'•---------•---•---•----•---•------•--•---'--------"-------•----------"-••--------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ------------------------ - 4 ` ordinances, State laws, and r les ind regulations of the San Joaquin Local Health District. {�d/-or Contract ------- --- - ----------- --- ------------ (Signed) - ---------------- i ---------------------------------------- se By:. {Plat plan, showing size of !ot, locaFion of min relation to-wells, buildings, etc., can be placed on reverse si e. FOR DEPARTMENT USE ONLY - U -,-------------d------------- t .�� e � � �, D ATE 1 BY �-_- REVIEWED 13Y- DATE------------------ APPLICA lON ACCEPT ---------------------------- = ---•----- ....-•-- ` ---•--------- Alterations and/6rrecommendations:- BUILD PERMIT ISSUED---=__---- _ s 3 - - -- - ti ------------ `- -z ------------------- --------- - - --- - --------------------- --------------- Date--------- / �` --------------------------- FINAL INSPECTION BYi.--- - .=--- -------- ---- SAN JOAQUINY LOCAL HEALTH DISTRICT 300 West Oak Street 124 sycamore Street 205 West 91h Street 130 South American Street Manteca,California Tracy,California Stockton,California Lodi,California y _ lA' EG-9 REV19Eo 0-59 F. '00-2M 6.60 ti