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FOR OFFICE USE: I-A) .. ....7.A_4!.S_=... Permit No. Z.Y APPLICATION FOR SANITATION PERMIT , ................ ..........t........... ..........................................3...;---�.pl (Compl--bin Duplicate) Date Issued ...................................._.............. ... This Permit Ex it i-Ve-ar From Date Issued F,?— I40-10 Application is hereby made to the San Joaquin Local Health District for a per�miitjtt construct and ',stall the,/,W:, k herein described. Tk* joa ion4s e an 549. phis-appli ti -made cje with County Ordinance No Owner's Name. j .......... Phone...-_... ...............................-----------------........................... Address---- .... .... ............................................. Contractor's Name........lev..*.. .............................................................•-----------•-------- Phone---------........---------------- Installation will serve: Residence [Apartment House (3 Commercial E] Trailer Court [3 Motel El Other Number of living units: Number of bedrooms _0K.. Number of baths A... Lot size ................................... . Wafer Supply: Public system ❑ Community system El Private WRO'tepth to Water Table 45'.4-fte 4� Character of soil to a depth of 3 feet: Sand [] Gravel El Sandy Loam E] Clay Loam 13 Clay [-I Adobe M-'-'H*ardpan i Previous Application Made: (If yes,date....... ............) No JR-' Now Construction: Yes'@? ^No [D FHA/VA: Yes �'Noj TYPE OF INSTALLATION AND SPECIFICATIONS: i z-1 (No septic tank or COUP001 permitted if public sewer is available within 200 feet.) 4*1 _4 Septic Tank: Distance from nearest well.A.....Distance from�ounclation_,O_ -------------M a f 6,:a ellon!......./-- ---- of No. of compartmentso?..fquid deptV_--r../7! apacity�w_ 17.4--t ...............Liquid.......Or Disposal Held: Distance from nearest well./o ..Distance from foundation../A... Distance to nearest lot line.,. Number of lines Length of each line..190....................Width of ............... Type of f1ter materia �rlj fit .0� Depth OA D th of filter maIerial.Ae!!!_._._`.....-Total length.;�. 1A---).......5 ,0 /1 00 a ion.,%A?..........Distance to nearest of"lino-Q.. ......... Rep 1:g5elilP Yi Distance to nearest welk"0/100............Distance f fo ndai' Number of pits -1-------- ...Size: DiametarzO, DepfRo 74 /......__Lining material-Wa Cesspool: Distance fi-om nearest well.................Distance from foundation....................Lining material..--........_...._..__...___.......\1� �4�- 0 Size: Diameter....... . . ......................Depth.......................... -------_--------------Liquid Capacity--------------_------------gals. Privy: Distance from nearest well......................................:..........Distance from nearest building.._-.......---._-_--.-.-.-._-.---------.-. , ❑ uilding------------------------------------------ 171 Distance to nearest lot line...... ............................................. .......... ............................... ................................ em-,<�a Remodeling and/or repairing (describe):_/.27�.A*�0'_ ............ -------------------------------------- ...... .................... .......................................... ............... ........... ------------.... /-4- --------_-_-......................... ......... . ......................................................................... .......................................................... .......................... ..................................................................................................................................................................... ...................................................... I hereby certify that I have prepared thisapplicationand that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. rt ....... - - ------------- ... ...................................jQ=gc==d;Ior Contractor) (Signed).................... ##4(�e ......... By:...................................................................................... .......(Tif lei----4�''#4# (Plot plan, showing size of lot, location of system in relafi o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... > .......... DATE....... ......V----.............. --- --------------------- ---------------------------------- REVIEWEDBY................•----...........-.....-....-_--_----------� - ....... ............................ DATF__....................... .................................. BUILDINGPERMIT ISSUED............ ............................--^---------- ...c------------ -----. DAoTE...................................---------_----_-------- Alterations an or ------ ............17......... CY ----------------V .......7� ..... ------- ........ ....... ------------------------------------ ......................................................................... .................................................................................. ........................................... ....... ......................................................................................................................................... ............................................I..•---------............... -_.. ------------- .. .. .. ........................................................................................ ............................. ...................................... .............................. e-- FINAL INSPECTION BY:......................... -- ---- Date......... . .... F............................... $IN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxellon Ave. 300 West Oak Street 124 SYCaMOTS Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.00.