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FOR OFFICE USE: ....... APPLICATION FOR,SANITATION PERMff Permit No ........ (Complete in Duplicate) Date Issued _"A"/� ........... .......... This Permit Expires I Year from Date Issued Application is hereby made to the San Joaquin Lorca' Health District for a permit to construct and instal the work herein des-crjud. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION . ...... .. ....... ....... _�'0 Id", ho"��S_ - Owner's Name .... . ..... . ..... p Addrrss................. Contractors ....... Installation will serve: Residence voApartment House ❑ Commercial F1 Trailer Court [3 Motel n Other M Number of living units: - 4. . Number of bedrooms _*. Number of baths Lot size ------- Water Supply: Public system El Community system M Priyate 2�"Dapth to Water Tableba. "t. Character of soil to a depth of 3 feet: Sand P Gravel F1 Sanely Loam [] Clay Loam, [T"Clay [3 Adobe [] Hardpan 0 Previous Application Made. (if yes, da!e_ ............. ) No F!!I- New Construction: Yes r; No [3---FHA/VA: Yes E-11 leo TYPE OF INSTALLATION AND SPECIFICATIONS-, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sec*ic Tank: D.'slance from naarest ......... Distance from Material._-..--._._......._....._.___,-... No. 0.1 compa rtrne ...... .S*,ze_._.___.__._ ....... . L.quid dep.f% .... ... C -An a C4, ty.. ........... Disposal Distance from nearesf'we1,ArW.../... Distance from foundation,.-..... __.Distance to nearest lot line _541,) ... !`�,!jmber of lines.. bengtti of iii<tch line Width of trarich Type of fi'4er Depth of filter Seepag Pit: Distance to nearest well../VY-6.," ....... Distance from foundation-_.._7.,_,.-..Distance to nearest lot l/ine-s ~lumber of Isspook 0-1stance from nearest W01_ Distance from material_ ........ ............. F -I Size: Diameter-... ... ...... d Capacity,, De -th ....... . .. . ..... ...... ...... .................. Lf ui Privy: D:starico from nearest well ..........................................__..Distance from nearest boding...,,...... M Distance to nearesi lot iine. ..... ..... ............... ........_.._...._-...__,____._,•.__ ...... 'Rertiodeling and/or -epairing_7l0 ....................... ........ . ....... ___ _ .... .. ._._ . .... ............ __ ...... ......... 1 -1 ............ ------ .._____ ...... ...... ............... ........... _.....w.---__...__..._.... . ....... -_1..,...._._1 -...- ........ __ ...... ........... I hereby certify that I have prepared ibis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r and regulations of the San Joaquin Local Health District. (Signed)._._. ...... ...... ..... ow and/or Contractor) .... . ...... 4,4 (Plot plan, showing size o location systemin re flon .. to wells, buildings, a4c.. can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY, .. ..... .».........._._------._...._....__.. DA TE ..... 411 .............. REVIEWEDBY. ............. ........ _-_--.,.x.--_ ....... I ...... . .............. .......... ___, DATE__ BUILDING PERMIT ISSUED..... .... ____ .......... ............... .... . ............ ___ ............. ... DATE .... _ . . .... ......... Alterations and/or recommandafions-, -1 I'll 11 1 1 ... ......... ....... ...... . ............ . . ... . ....... ........... ...... ........... ---------- - ------ ............. RNAL iNSPECT10,1`4 Date ........................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1. Hateltan Ave. 300 West Oak street 124 Sycamore Street 205 W*%t 9th Street stockt*A, California Lodi, California Manteca, California Tracy, California $'. P. C r.