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FOR OFFICE USE: ! Permit No. ----•.............••--•. a-.-1�� G-------�.-�--- ----- APPLICATION FOR SANITATION PERMIT (complete in Duplicate) pate Issued ":I This Permit Expires 1 Year From Date Issued _.. - Application is herebymade to the San Joaquin Local HealthdeplNoc for o a permit to construct and install the work herein described.- This application is made in compliance with County _ r -- - -- --------- j42-414. JOB ADDRESS AND LOCA VON_ _ -/-- -- Phone------------------- ---- - ---------- ---------- - ------- y- - 4U 4 Owner's Name--- ' -------------------•---------_----• ------ Address-- - � - m -�1--.------�---- Phone 7_�a .• --- ---• ----- � Other Contractor's Name____ Trailer Cour ❑ Motel ❑ Installation will serve- Residence [�P,parfiment House ❑ t Commercial ❑ / L �________________________ Number of living units: -_-_� Number of bedrooms _3--_ Private �Number of baths j--- Lot size ___ epth to Water Table Water Supply: Public system ElCommunity system 11Cla Loam El Clay E] .Adobe Iardpan ❑ , Character of soil to a depth of 3 feeiv Sand El Gravel ❑ Sandy Loam ElyNo [I Previous Application Made: (if yes,date-__.--_---,--------) No ❑ New Construction: Yes [&-. C] FHA/VA: Yes C]r'E . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Distance from nearest well-.-f �.---Distance from foundation__ d--------Material --- Ca acit l s�S-d Q Septic Ta y% Li uid de th__.---- P y-- No. of com artmenis----C-L..---•---------size- ___-- X-S G P � r pistance to nearest lot line_---------------- "'l Distance from.foundation�4---------; •• Disposal F' Id:' .Distance from nearest well- ------- Number of lines v2 Length of each line.54_- lQ- .width of trench_______---- ------ r Type of filter material_"- -/ dC- -Depth of filter mater-lal.---I-- ---Total length-- ----��------- ---------�--- ,t; pistance to nea est well--f -- Distanc m ---- foundation Distanc�g to nearest lot line__ - ------ 1 Seepage _.. Depti,_. -�_ ---- -- ----- -------------Lining Linin material__ __ _Size: Diameter____ - Lh' . _ - - Number of pits .... g Distance from nearest well_______________-Distance from foundation._-__--__-_.----"--Lining material------------------------------------- CesspCesspool: ool: --- --Liquid Capacity- ---------------------------g ❑ Size: Diameter----- --------------------------------Depth----- ----------------------------------- - Distance from .nearest well ------ ----- Distance from nearest building------------------------------------- ---------- ---------------------------------- . I Privy: ------------------ ❑ Distance to nearest lot ine_---------------- �. - Remodeling and/or repairing (describe):--------------- ------ -------------- -------------- --------------------------------------- --------------------------------------------------------- Remodeling and/or repairing (&Jlbe):--------------- ------ -------------- --------------- - i ---------------------------------------------------------- ----------------------------------------------------------- --------------------- - ------ ------------------------- - ------------------------------ ------------------------------------------------ I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun y ordinances,Alte laws, and rules and re uI tions of the San oaquin LocallHealth District. Owner and/or Contractor} ------ -----A _( ig ) ----------- -------- (Tlt e - - ------ ------------- --- gy:•--------------- ----------- t,-- y (Plot plan, showing sixe of lot, location of s stem in rel 'on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---_--------- - -- ---------------------------- DATE------------------- ------ REVIEWED BY DATE------ ------ -------- --- ------------ ----- ---------- -- t BUILDING PERMIT 155UED_____-.-==•----• ------ 44-- ------`-"``----------- - Alterations and/or recommendations:__-._-.-- � � - _ !--"_--- a -• ---------------------------- �-- - ------ ---- ��t.------ ------ •---- --------------- -------------------------- ---------------------- os/(:O, ---- - ---- ------------- Date____- . .---------' � FINAL INSPECTION BY:------ QUIN LOCAL HEALTH DISTRICT . 124 sycamore street 205 West 91h Street 1601 E.Haielton Ave. 300 west Oak Street Tracy,California Lodi,California Manteca,California Stockton,California . F.Rra