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FOR OFFICE USE: --_--.------.-_--------------------------------_--_:lt APPLICATION FOR SANITATION PERMIT Permit No. .12----------------- 7- 3 -M, (Complete in Duplicate) Date Issued ------------------ --------------------------------------17M This permit Expires 1 Year From Date Issued ........ Application is hereby made t6��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 Ordinance o. 549 O _7 - --- -------- JOB ADDRESS AN I�O - ----- -- ----- Owner's Name-- - -•---------------------------•--•----------- ;/ -L Lr--- �-------- Phone---- Address ------------•• I ` ----------------------- - ----------------------------------------------------------------------- -------... Contractor's Name--------- !� -- -- - ---------`__------------ Phone4 Installation will serve: ResidenlM e Apartment House L❑ Commercial ❑ Trailer Court, ❑ Motel ❑ Other ❑ F Number of living units: ��'.--- Number of bedrooms _--VNumber of baths Lot size --------------------_--_ i Water Supply: Public system" Community system ❑ Private ❑ Depth to Water Table --_---._ ft. Character of soil to a depth ofl3 feet: Sand [-] Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Lk Hardpan L] Previous Application Made: (If yes,date_------_.._-."'"._._1 No New Construction: Yes ❑ No X_ FHA/VA: Yes ❑ No,> , TYPE OF INSTALLATION ANID SPECIFICATIONS: `. (No septic tank or cess�,00l permitted if public sewer is available within 200 feet.) i Septic Tank:I, Distance frI m nearest well- Q_t E bistance from foundation-------------------Material------------------------------------------------- ❑rKI5441�G No. of compartments---- -------- - ---- -- --Size------ --------------------Liquid depth--------'------- ------ Capacity---------------------- { Disposal Field: Distance from nearest well_VrQIU�Distance-from foundation._;�•�_f______.Distance to nearest lot line._ — Number of'�lines____ g Q?D.-- [� ,I t'��- -Z..L-.L-� _ _ Len tf1 !of each line___ �r____.Width of trench-.24!�____________________ Type of flier material _ __._Depth of filter material----_1______-_____Total length-------m__ ------------------------- r -------- --------------- y - r \ 4 Seepage Pit: D stance to nearest well__ 0 ----DistanceW_ m undation_. _._.___.Di3 ce to nearest lot line ._.--_---_-_ �! . Number off pits4OW_ _ 11)....Lining material___ -.--.Size: Diameter___ p V Cesspool: Distance from nearest well__--_-____._---Distance from foundation....................Lining material--.-.___-_--_.___. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------.Liquid Capacity----------------------- ----gals. Privy: Distance from nearest well ---------------------------------___--------Distance from nearest building-----------------------------_---- ----_. _ ❑ Distance to nearest lot line- ------------- - --------------------- - -----------------------`--------:-----•----------------------- ------------------------------- Remodeling and/or repairing describe)---- A� - ------ -------- ------------------------------------- ----------------------------------------- ------------------------------------------------------------------------- - ---- --=-------- II ' ------------------------------------------------- ----------------•------- --- -- --- --- - --------------- --- !I I hereby certify th 1 .ha "e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and r es and regul ions of the San Joaquin Local Health District. (Signed)---------------- ------ ------------: - - --- - ----- ------ -------------------------- ---(Owner and/or Contractor) Plot Ian, showing size of lot ------�1----- ----� � - - �.-------- -----------... ( p g location of system in relation to wells, buildings, etc., can be placed reverse side). �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 -------------------------- DATE-- REVIII EWED BY -------------- ------------- -------------------------------------------------------------------------------- DATE------------------------------- h ------ ----------------------------- BUILDING PERMIT ISSUED._ - --- ------------------------ -------------- •— -------------------------------------------------------- DATE-------------------------------------------- ------------- Alterations and/ recommendations-------------- ------------------------------- --.- •- -�' II I ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- FINAL INSPECTION BY: . .!. { ------------ - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California