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FOR OFFICE USE: l - APPLICATION FOR SANITATION PERMIT Permit No, ----------------------------------- --- --- ---------------------------------- -------- ----I........ (Complete in Duplicate) � Date Issued _55�_ ------____----____-----------.--------------------------- This Permit Expires 1 Year From Date Issued Application 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. 549. JOB ADDRESS AND LOCATION----; L� ------------- --------------------------------------------------------------------------- Owner's Name-------------- - TrY-------•------7:'f4-17 -�--EiJ v---------- --------------------------------------- Phone------------------------------------ Address ----------------------- -------•--- Address--------------------••--•----------- -j-J---•-------------------------------------------------------------------------------------------------------------------------------•-----•- Contractor's Name---------- " 1 � 1 -------------- _G,/ -------------rS-_�--------=------ Phone--------------------------- o -----. Installation will serve: Residence Apartment House.❑ Commercial E] Trailer Court E] ,iMotel El Other ❑ . r Number of living units: ---1... Number of bedrooms ___Z�Number of baths ___1_ Lot size ____- �6_U..1C__.16_st------------------------- i _ _ Water Supply: Public system 0 Community system'-ft Private❑ Depth to Water Table _.------ ft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loarn ❑ Clay Loam [I Clay ❑ Adobej' Hardpan ❑ Previous Application Made: (If yes,dute---------------_____) No t/ New Construction: YesX, No ❑ FHA/VA: Yes E] NX TYPE OF INSTALLATION AND SPECIFICATIONS: i/; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-O/_WDistance from foundation---- Mate'riaL__-__- �✓G' ------- _e No. of compartments-----------Z------------Size__s-�__� ,5+X.`"/_-----Liquid depth ._�_�__i___________Capacity__ Q---------- Disposal Field: Distance from nearest well..A_PN4E_Distance from foundation______- Distahce to nearest lot line____-- �_�____ (� Number of lines-__'_________._f-----------------Length of each line------------ !?---------- _.Width of trench_.___-?y__"______________ 'U Type of filter material___._AeC—,1C_Depth of filter material-------;l ".__.Totaf' length_"__..._-.._____.:._...". Seepage Pit: Distance to nearest Distance from foundation------ D..____.Dista'hce to nearest lot .� s. Number of pits.....t--/-----------Lining material Size: Diamei-er_-_--,.,�.1�.........Depth_.__._.__._-�.__.".__._____.__ Cesspool: Distance from nearest well--______--_.__Distance from foundation__________ ________Lining material_----------------------.-_--__-.---. El Size: Diameter- -- -------------------------------Depth---------------------- ----- Liquid Capacity gals. Priv Distance from nearest well- - ---------------------------------------------Distance from nearest building ❑ „�--...a..n _ ar�, „�..r - - ------------ --------------------------------------------------- Distance to nearest lot line-------------------- - - - ---- ------------------------�-�-- a Remodeling and/or repairing (descr b�e) 0140 // 7 34-L ` = - -------`---'------`S, ---------T[3-- ----------- --------a�_Iv<�------------------------------------------------------ t--------- . -- ---------"-------------------- ----- l F I -- ------------------------------------ -------- -------------------------------------------- --------------------------------------- --------- .0------------------- __ _ __ _____________________________________________________________"___"__.._..."_"________.____-_"_________"_"_""_______________________________________________.__-______-_-________-- .__---_...____..__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,'District. ------ (Signed) +_ a�- c c. ...._..___. ---------------I--.-----------.------------- t '-(Owner and/or Contractor ---------- _ { / I r ------------ --- Title (Plot showing size of lot, location of systemrela�fio.welf,, buildings,tett., can be placedifon reverse side). r s ,g'k r 't%-` r 4, ,*- ' } t R DEPARTMENT USE: ONLY' APPLICATION ACCEPTED BY ------- ----------------- --------------�=------- DATE-----� --- �-T------------------------------- - REVIEWEDBY------------------------------------ ---- --- ---------------------------- ------- I ------------- DATE ----------------------------------------------------- BUILDING PERMIT ISSUED__..__..-.. `--- --------------------------- -------- --------- - -------------------- DATE.------------------------- -------------- ------------------ Alterations and/or recom pdations:_- l f:.__.___. — 3 ----------------------------------------------------- z.� -•J -X -------- c/ -- -------------------------------- ------------------------ ---------- ----------- � `4xt_ r ----------- � - - ' ---'-`�------ `--pl---Q�.1-.r------------ -------------•----•----- ---------- ---- ------------•----------- ......... ---------- •-•----------------------- -------- ---- .» _ �S r I --•- ----- ----- - FINAL INSPECTION'BY: ------------------------ Date._.../- G 7 JOAQUIN LOCAL HEALTH`DISTRICT 1601 E.Hozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street s Lodi, California Manteca,California Trac California Stockton,California' Y. - F.P.CU. 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