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.,�,.��rT �-•r""'rw +�.�... vim.. 4-_ FOR OFFICE-USE: r _. ^^^"'' Permit No. --------------- APPLICATION��K—�SANITATION PERMIT ---------------------1, --- ----- - ------- ------ r ,)------- (Complete in Duplicate) Date Issued --- This Permit Ex fres 1 Year From Date Issue _ p Application is hereby made to the San Joaquin Local Health District fora ermit to construct and in the work herein described. This application is made in compliance with County Ordinance No. 549. p , JOB ADDRESS W LOCATI K-PA --l6_ _ -_.-_11---____._ Phone------ ------------------- Owner's Name -- --- --- •----------------------------------------------- -------- --- --------- --------- ---•-- ------r�l�riJ --------------------------------- -------------------- Address-----a 8--( .• -- ---- ----------------- Phone - Ph �- .__, ----------- -j -- Contractor's Name__ ".-• - -- -- ---• Motel ❑ Other ❑ Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Number of living units: __..�-" Number of bedrooms__- Number baths _"--- Lot size -- ---•------------------------ ' Community system ❑ Private Depth t - Water Table __.___.. f#. Water Supply: Public system ❑ Y YAdobe Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam Clay m ElNol❑ ❑F ANA:C1 Hardpan ❑ rd No El Application Made: (if yes,date--------------------) No El New ConstructionYes . ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within ton feet.} Septic Tank: Distance from nearest well-_--------------Distance from foundatiLn u�d_�e } --M"aterial------------Capacity._______. .__._------- No. ____ ❑ No. of compartments------------- Size q p . . ` - --------- --- Dispos Field: Distance from nearest well__.- -� Distance from foundation__ d"�---------Distance to nearest lot line_s--------- _ . Numbe� of lines---------- ------- -- --_Length of each line-------- Q ------„----Width of french e of filter material---__�t.R-----------Depth of filter material-.-_._.1_. _”------ length___ Q-�--=- Yp Seef�' Distance to nearest well_____._L�'°" __Distance from foundation_._L�_�_____.__.Distance`toDn�a+est �%ine- -----=------- Number of pits------/--------------Lining material-_-- --1 '------" Size: Der_ --- _.7------ -- - p Cesspool: Distance from nearest wellDistance.from foundation....................Lining material_. .__".....___. _ ----._.____.s. � ---Liquid Capacity-------------- gals. ._De th----------- ---------- --- ------ ❑ Size: Diameter--------------------- p I ______:--- "--- .._",-Distance from nearest building-------------------- Privy: Distance from nearest well-.------_---------=-- - 4 . -------------------------------------- Distance ------------- Distance to nearest lot line----------------- --------------- --- -----_--------- R ------------------- --- Remodeling and/or repairing {descri e):-___"-- -"- ------- ----------------------------------------------- --------------------------------- - - .4016 --------------------------------------------- - I hereby certify that,I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State A ws, and rules and regulations of the San Joaquin Local Health District. _ nand/or Contractor) Si ned - ---------------------------------------------------- --- ------------------- -- ---- [ 9 - } _ en size of lot location of syst�p -- -- --------------em in relation to'w'ells, buildings, etc., can beeplaced on reverse side). (Plot plan, showings } FOR DEPARTMENT USE ONLY DATE-- G ---------------- APPLICATION ACCEPTED BY_ __ _. DATE------------------------- - ------------------------------ REVIEWED BY----- -------------------------- ----------- ----- ---------------------------------------------------------- ------- -------- BUILDING PERMIT 155U "-"------------•-- - ----- -------- ------------ Alterations and/or recommendations:------------ ---- - -------------- - Date. -- ,� ar �- ----- ---- -------------- FINAL INSPECTION BY:.. . -- -- -- - -------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ava. 300 West Oak street 124 sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CG• `