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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 2 .......... .... ...... (Complete- in Duplicate) Date Issued This Permit Expires I Year From Date Issued iplication 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. 649. 0 (7 ---0_? 0j...-0-5 -- ..... ,JOB ADDRESS AND L06 AlK Owner's Name.._... ...... .......................... ........ Contractor's Name., ........ Phone................._..........._..... Installation will serve: Residence Allpertment House Q Commercial Q Trailer Court ❑ Motel n Other 3 Number Of iving uniit: Number of bedrooms Number of 'oaths _/... Lot size rt _ 114 ....... Water Supply: Public system n Communify system r,_1 P,i,,+, [ l. Depth to Water Table -.7.6 ft Character of soil to a depth of 3 feet- Sand F1 Gravel F-1 Sandy Loam Clay Loam 0 Clay M Adobe F -I Hardpan 0 Previous Application Made: (If yes, date_ I No [] New Construction., Yes ❑ No f -I FHA/VA: Year M No M TYPE OF INSTALLATION AND SPECIFICATIONS - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank. Distance from ncorftf well..,........... Distance from foundation .... ....... .................................................. r ..." Capacity___ ...... . No. a, cornpartmelts___ ... ... _......,.,_Liquid Disposal Field: Distance from nearest weil,%M ........ Distance from ioundatlon_tO ... ... ..Distance to nearest lot r1ir, Nimber o= . ...... Length of each Ii, re_ __..Wjcifh of ...... T.......... Type of filter Depth of filter mafer:al --- *4 ... ._Total iength_111 Seepage Pit: Distance to nearest we:'...j- from ioundation....20� ....._.D tance to nearest lot ;ine ... ........ Number o-' ....... Linirg S. Cesspool: Distance from nearest well... -..........Distance from Lining material....... . . ... . ...... ❑ Size- Diameter. .......Depth..... ............._.......Liquid rivy: D'4stance from nearest well..................................................Distance from nearest building............_........................... Distance to nearest !of ............ .. .. ........ ........ Remodeling and/or epa*r;ng {describe):........ .............. _w...............,...w ....... . ... ............ .. ...... ............. ...... ...... ...... ............. _ ............. ........ ................ ... . ....... . . .......... ........ I hereby certify that I have prepared this application and 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 D;sfricf. ............ ......... (Owner and/or Contractor]- IPIOt plan, showing size of lot, location of lys+enri in relation to wells, buildings, etc., can be placed on reverse side). -....W......__ FOR DEPARTMENT USE ONLY . . .. ......... APPLICATICIN ACCEPTED ...... - ------------- --- -------------- DATE REVIEWEDBY._....................._.._................_..........................._.........................._...» DATE........_ ....... BUILDING PERMIT ISSUED.......... ___ .... . ..... . ...... .__ .... .. DATE__ ............ ......... ....... ................. Alterationsand/or recommendafions:..._... ........ __ ....... __ .................... - ........... ...... ...... ... 11 ...... ...... -A .. . ................ ... ................... ................. ... ...... .......... .......... . . . ................ . . ........ ...... ...... ......... ...... _ ... . ............ -1111- ......... .. . ............... .......................... ....... ........... ....... I ...... ..... . .... .......... __ ................... 7 FINAL INSPECTION Date ... -4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 9.14azallon A". 200 WOO OOL sftvitl 124 Sycamore Street 205 Weft 9fh Street Stockton, California Lodi. California montoca, California Tracy, California 4 2M 1 67 V, rqivor