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Y Permit No. .___C.- --- ---0 �f / APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued -LI /�• �install work herein described. App is tion is hereby made to the San;Joaquin Local Health D'istr'ict for a permit to construct and This application is made in compliance:with County Ordinance No. 549. JOB ADDRESS AN LOCATION ------ --------- CI --- ----- ---------------- Phone-------------------- ------ • ---------`---------- Owner's Name ------ AddressS / r -"sv ?'"".+-`------------------------------------- Phone Contractor's Name_ -------- ------ a ------------------------------------- -------. Installation will serve: Residence ,.Apartment House ❑ Commercial ❑ Trai4er Court ❑ Motel ❑ Other ❑ < F u ��------------------------ "�-" Number of baths 1_--__ Lot size ""� Number of living units-- __------ Number of bedrooms �, _ft. ' Water Supply: Public`system N Community system [I Private E]' Depth to Water Table PP y' Clay Loam Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y ❑ y ❑ Previous Application Made: Yes ElNo,,Dk New Construction: Yes W/ No ElFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) /y ��____Distanc from foundation--- _l! Materia_L,�h'�'t•� - (!r ---- Septic Tank: Distance from nearest well__-___._ ��/ - _-Capacity__.___ No. of compartments------ :-----------Size-------yj Liquid depth--.--- --------- Se ndation___�6------Distance to nearest lot line___ 1 Disposal Field: .Distance from nearest weld----____________Distance from fou Width of trench___._"��-�------------- "�---------- j Len th of each line--------- __ Number of lines. /"" g l� To#al lengthx"Q -------------- Type of filter material=_� Depth of filter material---. - --- ti y �Q__.Distance'to nearest lot line--- % Pi : Distance.fo neares# w-11 01 ram &undation .__. De th ------••------.-- N bar of. pits_._._ _-Linin materialDiameter________ _. ._ p o Cesspool: Distance from nearest well----_-._-- "-"---Distance from _---------- L;nuid Capacity gals.. O Size: Diameter----------------------`--- -----------Depth------------------------------ -------------- q p tY ❑ Distance from nearest building ------ -- Privy- Distance from nearest well-----------------" --------- ❑ ------------------- -Distance to nearest dot line_.._____------------------ V -----�.�--- ------- ------------------ Remode ing and/or repairing• {describe:__. ______- " - = ------------------------------------- - = -"--------" ----------------------- - ----------- ----------------------- - be * I hereby certify thaat I have sprepaand reduthis,a olI at the San Joaquin Local Heae work lth h Distr ctn accordance with San Joaquin County ordinances, State laws, i. -----------------------(Owner and/or Contractor) ti 13 :---.cc. Title (Sign )----•--- -- ----------------------------------------- By: --------------------------------------- (Plot plan, showing size of lot, location.of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---------------------- DATE ' APPLICATION ACCEPTED BY------ - -=--- DATE--_-__-- --------------- REVIEWED BY---------------------------------- =_ ----------- DATE PERMIT ISSUED------------ ------------------------ ------------------------------ ---------- - ------- - -- -------- -------------- DATE---------------------• ------------------ ------------------- - --------------------------- - ------------------ --------------------------- Alterations and/or recommendations:__-:_ __�- - --------------------------------------------------------- I __ _ _-•-___•-"•"_•""_-_._"".___.__.. ------------------------------------------------------------------ --------------------------------- ------------------- 4 ---- _____ _______---------- _------__-------_______________a____--._ � s ✓-1.-�:.�-�-k.-.5__-.__/,_ _------•----•--- ------------------ FINAL INSPECTfON BY.______ �----------- - ---- Date.___-- _- I r SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" S+reef 13o South American Street 300 West Oak Street Tracy, California Stock+on, California Lodi, California +. Manteca, California E5-4-2M , Revised 1.57 F.P CO.