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-.r-R 10 Permit No. .J. :3l.�S. �r :�. -rG_-------- APPLICATION FOR SANITATION PERMIT .. ... - _1 (Complete in Duplicate) Date Issued g__�=--------- ------------ ------------------------------------------ This Permit Expires 1 Year From Date Issued ----------------- -------------------y ------- --- -- Application is hereb made to the San Joaquin Local Health District for a permit to construct and install the work here'sn described. This application is made in compliance with County Ord'nan a No. 549. JOBADDRESS Q jL0CTl0N_.1-r707-----•-------- --------------------•------•-------------•--------------------------------- ---- ---------------•--------_ ------------- Phone----••------•-------•--------------- Owner's Name------ --- -- •--------------------•----- -te _Address-----------�- ------•----------------------------- '�' Phone---...--•------------------------•- = ------------------------ - - Contractor's Name__._ _ - - - •- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Trailer.Court �� Number of living units; .__-___ Number of bedrooms __-'Number of baths _1__-- Lot size ._..----x------_--_-___..__•------------------•---------- Water Supply: Public system [Community system ❑ Private ❑' Depth to Water Table _66_ ft. k Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes;date--------------------) No 0'�' New Construction: Yes [RNo ❑ FHA/VA: Yes ❑ No [ ' TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.} r Septic Tank: Distance from nearest well-___�------Distance from foundation---P---- _ ___-___...-_____-___________-.___.�___.{� -----Capacity_ d -`-`-" No. of compartments______ _Size_._ -SaL.-1-------•Liquid depth___'`l______________ I . .. Disposal field: Distance from nearest well---.____.--Distance from foundation_1___P________-11P -4t fine---------------- st lo 1 Number of lines_-___-.-1_______-- --__Length of each line-_ �----•--y�--- --------- , Type of filter mate rial_!a ---------Depth of filter material ---- dotal length___-4v__________________J__�_______ l Seepage fait: Distance to nearest well____~__-____._Distance from foundation___./O--•_--.--Distance to nearest lot li�e_`5_____________ oGjf--------Size: Diameter__ 3-. ---------- Depth ° `r a Number of pits:___�:F__.__..__ ---Lining material�___- Cesspool: Distance from nearest wellDistance from foundation___________________lining material_-..---------------------- — als. ❑ Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity---------------------------g Privy: Distance from nearest well-------------------------- ____ ., --- --____Distance from nearest building------------------------------------- ❑ Distance to:nearest lot line----------------------------------------------------------------------- �. . k`k ---------------- �a ------------------------- Remodeling and/or repairing '[describe)-------------------------- �------------ - ---- •-------------------------------------------:-- -------='---------_ ----- --- ------------------ -- --------------------------------------- Pp-I----•--- _`--•--------------------------------- [ I hereby certify that I have re ared this a licatio and that the work will be done:in accordance with San Joaquin nun ordinances, State laws, and rules and.regulations the an Jo qum Local Health District. r _______(Owner and/or Contractor} LL" (Signed) --------- ----------------- ---------------------------------------------- --------- ---------- - - ------------------ ------------- ---------- ----------------------- to ------ = ------------------(Title} Y [Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be.placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -- --- h --i'--------- --------------------------- DATE lr �=�� 3----------------- - ---- ----------------------------------------- --------------- DAT --------------------------------------------------- BY BUILDING PERMIT ISSUED-----._--------------------- Alterations ---------------- -- DATE ------- REVIEWED Alterations and/or recommendafiions:.__-___. -------------�` ' = == f_. -=-- -------------------------- ------------- l -•---------------- -------------------------------- - --- ---- ---- ------------ _________________--------- ---------------------------------_____ FINAL INSPECTION BY:------- Date_.. ----e.9- ----- -------------------------- --�� SAN JO�AQUIN LOCAL HEALTH DISTRICT 1 124 Sycamore Street 205 West 9th Street 601 E.Hazelton Ave. 300 West Oak Street Lodi,California Manteca,California Tracy,California Stockton,california ES 9 REVk5ED R-59 3M 3-'63 r'.P.Ca.