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OR OFF, JSE: " / -- , j a�' - _ Permit No. -------- -..__..-. APPLICATION F611 SANITATION PERMIT f ----------- --------- �31 ,:r 9d -- (Complete in Duplicate) ` S Dot issued __.._...-� (�---- --------------------------------- "-- ------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct nd install the hereindescribed. liance with County Ordinance No. 549. This application is made in comp ` ------------- " �/7 � (Y � ----- ------ - ----- -p--------•---- ------ --------- JOB ADDRESS AN L ATION Phone- ---� ----- -----------Owner's Name - -- -. � --------•---•- Address---•------•-------------� -•--------"------------ ----•--------------------- - � f O -- h�------ -----------------------------------------------••-....-:- --•-----•- �j 4 ..1 v___a ---- Phone..`✓l..1/ Contractor's Name------------------- --------•--------•---••---- -• -- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: _-l.---- Number of bedrooms .._3. Number of baths -- Lot size ...... ----- Water Supply. Public .system � Community system $, Private ❑ Depth to Water Table -_.-.-- ft. Adobe � Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ No Previous Application Made: (If yes,date---__--------------) No �2L_New Construction: Yes ❑ No -FHA/VA: Yes E] 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 foundatiLquid depth "Material_---- Capacity.-----_-- ----------- ❑�15� ---- -----Size q f(njfc No. of compartments._...._..__.._ Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--------------- J Number of lines-----------------------------------Length of each line.---------------------------.Width n trench-------------:------- �K t Sx1 C� r (" Type of filter material-------------------------Depth of filter material.---------------- ----Total length_._....-------------------------------- i !1 Seepage Pit: Distance to nearest well---/U 0.4)07 istance4a,4U,_,Sjze. mndation_".__7- ...._...D Distance to nearest 1 --- ---- j� Number of pits..' --Lining material.....- Diameter-... Cesspool: Distance from nearest well..___..-_..__.-Distance from foundation....................Lining material-_..---------------- --- aks. Size: Diameter-------------------------- ------ --Depth----------------------------- ------- ----- -----Liquid Capacity- ------------------ El ----------------- 9 I ❑ from nearest buildingI Privy: Distance from nearest well------------------------------ ------------------------- ------ Distance to nearest lot line ............... . . --------------- ----------- d El Remodeling and/or repairing (descri e):.__" --- -- -- _.___________-----"..__---__-- ----------------------------------------------------------------------- ---- p --------------------------------------------------------------------------------- - ------------------------•---------------- -------------------- ! hereby car#if that L.hax repared this application and that the work will be done in accordance with $an Joaquin County I' ordinances, State y s, a d rule and regu '}ions of the San Joaquin Lo cal Health District. �D. ----------------------- -- --- -- ..(Owner and/or Contractor) 5t ned ---- 1 ( ig )---------_------ (Title) BY:---------------------------- ---------- ----- (Plot plan. showing size of ot, location of system n relation to wells, buildings; etc., can be•place on reverse side). FOR DEPARTMENT USE ONLY _ �. �'� DATE---- - - y ---- -------------------------------- ri APPLICATION ACCEPTED BY _. - - --------------------- DATE-----. C ----------------- REVIEWED BY----------------------------------- ------------------- -------------------------------- DATE J BUILDING PERMIT ISSUED----------------------->14 �/� -------.ice , � - - -=-'�'4'----�'-'-„-----'�--'-`-`..---rte�:--=---�"-•-_-------- -CY----- ------- ---- - Alterations and/or recommendations:-....". - -------------------------------------- - _ _ _---......--. ---------------- ------ --------- --------------- ----------------------- --------------------------------- ----- ------------------------ ..-. ss --------------- Date-------- --------------------------------------------------- FINAL INSPECTION BY:__ c- T SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 Oak Street 124 Sycamore street 205 West 9th Street t Lodi,,CaliforniaCManteca,California Tracy,California Stockton,California