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FOR OFFICE USE: � .------"---- APPLICATION FOR SANITATION PERMIT Permit No. ..l_..77 Jf ------------------- (Complete in Duplicate) _ Date Issued `5= ---�- -------------------- -"----------- - --- - ----- -------- ------- This Permit Ex fires 1 Year From Date Issued r ----- -- p� - A lication is,hereby made to the San Joaquin Local. Health District for a permit to construct and install the work herein describe . This application is made in compliance with County Ordinance No ' ------------- --�OCATION-___JOB ADDRESS AND ,L ' Phone---------•-------------•------•---- X ------ ------------------------- Owner's Name-----,1'-- ----•---•----- •-•--•------------•---•------------ _ '_.-------••--------------------- -------•- Address +� ` '�' ------••------------•-------------- t ---- "� 13'X---�_�. ------ -- - One • : ` f--------- Contrac#or's Name-------_-_-•- ---- Other Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel �] Installation will serve: Residence , . & p y i•'p{ �.I b _ __--___ Number of living units'T__:---- Number of bedrooms -3----- Number of baths J------ Lot size _--- - . i ° Depth to Water Table �_n__ ft. Wate; Supply: Public system ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑FHA/VA:❑Yes ❑rdplvao Previous Application Made: (If yes,date---------------- -1 No © New Construction: Yes No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool.permitted if public sewer is available within 200 feet.) y t� i N Septic Tank: Distance from nearest well--- from foundation___�_9__"" -.--.Materia:.."_______""----------------•------- ------~ L! P Y No.,of compartments_---�'.----------- - Size_ �--.�:�-._sl"�_..Liquid depth----- -------- Ca Capacity--/--7 nce st lot i Dis�osaI Field: Distance from nearest weil..�9--.---- Distance from foundation_ gip__"--- Width ofttre the} �'-��eB_�____--__--- p . . Len A of each line------I� .... f Number of lines ----- -- -------- --------- 9 De th of.filter material--- - -- -------- Total length_; -o ---- - i Type,of filter material_- p Distance to nearest lot line_-/.*- ------ 6 Seepage Pit: DiMance to nearest well___�:q--__------Distance fro foundation ameter-----3 ------Depth-_.P-r------------------------ k ------- ----_ ---- I Linin material __ . "- ------------ Z Number of pits_-. '------- g t Cesspool: Distance from nearest well ________________Distance from foundation._.__.__--_._____..Lining materia------------------------------------- Di ------------- els. -' Depth" =----Liquid Capacity- --------------------------g ❑ Size: Diameter-4---- ------------- ------------- I F Distance,from nearest building___-- ._--------------------------- Privy: ��,� Distance from..nearest well-------- =---------------- - _. k ❑ Distance to nearest lot line.__-----_------------------------- f . - Remodeling and/or repairing (describe)----------------------- ----- •---•------------ ---------------------------- .. ---- -----------------------------i .P Fj that I have prepared this application aandn Joaquin 'Local aHealth accordance with San Joaquin I hereby certify County ordinances, St a laws, and rules and .regulations of the 5 q --------- {Owner and/or Contractor) D� r �: ( .g )----- 1/ (Title) ------ ----- ... - - ------- _. {T t I - e) .w BY�-------------------•---•-"-'--"----" ---•: buildings, etc., can be placed on reverse side). {Plot plan, showing size of lot, location of system in relation to wells, FOR DEPARTMENT USE ONLY T � APPLICATION ACCEPTED BY �1---- ------------ DATE_"�_'._'"j_"��---•-- ------ -------- --------- ------ -- ------------------ ------- --------- DATE--------------------• ------------------- REVIEWEDBY----------------------•---------------------- -------------------------------- -------- DATE----------------------------------:------------------------- BUILDING ----- -BUILDING PERMIT ISSUED--------------------------- -_.--- ------- ------•---------------- -----------•----------------------- ----------- - Alterations and/or recommendations:______.-__."__-__...__ -- . _______. •------ -- ------------------ ------------- -------------- - #;o V --- -y FINAL INSPECTION BY- -- --- ---- - -- - j ' ---�-- Date"------ -------- - - --- ----- -� �----�---------- �------ - SAN JOAQUIN LOCAL HEALTH DISTRICT # 124 Sycamore Street 205 West 9th Street 1461 E.Hasaiton Ava. 300 West Oak Street Lodi,California Manteca,California Tracy,California - Stockton,California ES 9 RFV$S rID 5-59 3M 3-'63 F.P.CO.