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FOR OFFICE USE: '-�1��6. Permit No. . Z 7 �- - APPLICATION FOR SANITATION PERMIT / - - ) Date Issued _ l--2• � G --- (Comple#e in Quplicate ------------------------ ----------------------s :. 'This Permit Expires 1 Year From Date Issued p,pplication 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 Ordin ce No. 549, JOB ADDRESS AND LOCATION____ ______ ________ Owner s Name_____ --- -----•-------- - ----- -- -------------------------------•------•--- AddressContractor's Name-------_ Other Installation will serve: Residence [IApartment House Commercial ❑ Trailer Court' ❑ Motel ❑ Lot size . --------------- -----•--•---•-------•- Number of living units: _ --.Number of bedrooms __ Number of baths _: p ft Water Su I Public system [L ommunity system ❑ Private [] Depth to Water Table PP y' t Clay Loam ❑ Clay dobe❑ Hardpan ❑ Character of soil to a depth of 3 feet'. Sand ❑ Gravel ❑ Sandy Loam ❑ Y FHA/VA-. Yes ❑ No 0—' Previous Application Made: (1f yes,date__--,______ _______I No {�" Construction: Yes /[�1�0.❑ F TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation __._---_.---.------.Material.________:----- -- -y_,..__..___.__ :Y--- No. of compartrrents----•---•-----------------Size------------ Liquid depth Ca acit Disposal Fie Distance from m nearest well__.__-______ --.Distance from foundation---- ---_-------Distance to nearest lot line___.___..____.___ ❑ � Number of lines=--•--------•-------------------- -Length of each line-------------- of trench-- ------------••----------------- Type of filter material-------------------------_Depth of filter material------------ -------Total length---------------------• i • -.--Distance founda#ion.�Q.-_•---•---Distance to nearest lot line��-----�-- Seepage it: Distance to nearest well.rh� .-- Q-- -----Depth----- — ---------- Number of pits_._./--------------Lining material___--- .t" -Size: Diameter___ k Distance from nea{rest well----------------- from foundation._.-_______-__--__.Lining material__-_.._.___________-________..__-___ Cesspool: --Liquid, P Y �s Depth = quid Ca acit ----------------------------gas. Size:•Diameter-------------------------- P T � - ❑• ` :--Distance from nearest building----- ------------ :. Privy: Distance from nearest well __.__._---_- �. _-----_------------- pn ❑ Distance to nearest lot line_____________________________________ _ l/ Remodeling and/or repairing (des cribey:________..__-_______---_ 1 -------------------------- i -------------------------------------------- --------------------- ---•----------------------------=---------------- I hereby certify that I have prepare his application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rules and r g la ons/oftSan Joaquin Local Health District. ------------------------------ ------.(Owner and/or Contracto ( g Sined _ --------- - ---------------- I --------------------- - e- BY } buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, to 'on of system in relation to wells, FOR DEPARTMENT USE ONLY ' ------------------------- ------ DATE-----f--�°Z-•--`�-7---�-�-p------------•--------- APPLICATION ACCEPTED BY----------_ =-- - REVIEWED BY--------------------------------------------- ------- DATE ! BUILDING PERMIT ISSUED -- -------------------------------•-••---------•------•-•-------•- Alterations and/or recomm ations:__-=- =: - •--••--••---•-------•------•-----•--------------•-----•- 1 _v7-- ©_-- _ .-�--- - ------------------- ----------------- ----------------- ------ ----------- -------------- ---------- •-------------------------- ------------------------ -------------------------------- ------------------------- FINAL INSPECTION .BY-------- - --- ----- ��c .._ Date----__/-a- �- --.�C�------------------------ S JOAQUIN LOCAL HEALTH DISTRICT 13o South American Street 300 West Oak Street 124 sycamore Street 205 west 9th Street � Manteca,California Tracy,California Stockton,California L Lodi,California E5.9 REViBEo 9.19 F-P"C0.2M 6-6G