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' Permit No. _.�--- -------------• F R O F10E USE: • ,� -- ---1! "zf s APPLICATION FOR SANITA7lON PERMIT. !/ ------1� T ---�' �6" ----- ""-I d (Complete in Duplicate) - Date Issued ---(D • �� O -------- --------------------- --- ----------- ---_-----.--- !This Permit Ex fres 1 Year From Date Issued eb made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Applica+ion is her y4 This application is made In compliance with County Ordinance No. 54� 1 --•---- JOB ADDRESSD LOCATIONhone--------------- -- 'F, Owner's Name __ -"._t Address-------V------------ • ----------- Phone_ -------•-----• - ---- Other ' Contractors Name------------•---------------- ------------------------------------ ---�---•------•- -------- --- ercial ❑ Trailer Court ❑ Motel Installation will serve: Residence [I Apartment House ❑ Comm --•----- - Number of 4iving units: __..____ Number of bedrooms ______. Number of baths to"Wateo Talb4e��ft. L_ Private Dep Water Supply: Public;.system g Community system.❑ ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Y FNA/VA: Yes ❑ No ❑ Application Made: (If yes,date--------------- -----1 No ❑- New Construction'. Yes g No ❑ Previous App� _ 4 a TYPE..OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) I Material------------------------------------------------- Distancer l Septic Tank: from nearest well_________________ from foundation_-_.____-- ___"---- F '" .._Size--•---•-•------•- --°--•--- -•-Liquid depth--------------------------Capacity----------------------- Distance No. of compartments_______________________ / Distance from foundation/�� Distance to nearest lot line--- -----• Disposal Field: Distance from nearest well __.- _ Width of trench----- --�� --------------- Number of lines--------- ---- Length of each line--- -Total length________------ -------------_/-- �Type.of.fiifier 'material--- of filter �aterlal_-1" -- ej f - VO __Distance f om .fo ndation_l- Q Distance a to nearest lot line----------------- Pi}; Distance to neares `"e Linin material-7r_-.------- - .Size: Di ameter__43-3-------------Depth_------d--- Number of pits---�------------- g ,6. _ Distance from nearest weal -----_,_ __:-"_-Depth Ge from foundation----- Y---=______ Liquid Capacity_..._ ___--------- -------gals. � Cesspool: 1, ❑ Size: Diameter________________ IJ Privy: Distance from nearest wO - Distance from nearest building------ QJ( ------- ❑ Distance to nearest lot line_-.___.- f' GJ- --- I. ---- -- -- - ----- Remodeling and/or 'repairing (descrilae): __ -- -- ---- ----------------------------------------- t ---•------- ----------"------ hereby certify that I havesprepared uthis ap Ili ati San that i the L cai Heail heDistr a}n accordance with San oaqutn oun YO ws.,a pd rule 9 ----------------------- Owner and/or Contractor) ordinancesrfat aSi ned - --- --------- 1 g 1 ., J4�A ----(rt--- By:----=t__--n----==--------= (Plot plan, s4owing`size'of loci location of Sys#em.in_relatioh wells, buildings, etc.,.can be placed on reverse side]. FOR DEPARTMENT USE ONLY r / ' � --------------------- ' S. DATE APPLICATION ACCEPTED B Y'---=------------------ ------ ------_.. DATE_----- - ------ --- --------- REVIEWED BY----------------------'-hi---------------- -_----- -- ------------- ---------------------- --- -- --------------- -------- ATE----- ---=---• --------- BUILDING PERMIT ISSUED_'2J' _ - - s� .�- �a - Altera+ions and/or recommendations:��-_- -- --------------------------------------______________ 1 ----i- •----•---------- - -------------------------------------------------- Date....---- ---- -------------- FINAL INSPECTION BY:-.__ ." .4.-.- . --- -- -------- ----------------- -------- �Y -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street _ Lodi,California Manteca,California Tracy,California Stockton,California CS 9 REVISED B-59 31A 3-'63 F.P.CO.