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FOR OFFICE USE: G! APPLICATIO��R'-SANITATION PERMIT Permit No. ---••----•-•-----•-•--- ----------------------------------- ----- - ----- -------- (Complete in Duplicate) Date Issued _��-�-••-r°--r"• ------------------ ------- ----- ------ This Permit Expires 1 Year From Date Issued A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Pp This application is made in compliance with County Ordinance No. 54 . /.Z/� �d>;x -- ., JOB ADDRESS AND LOCATION--- - -------- ------ (� 7�3 r' 1 5 T -ir phone_:. _ _ -------- Owner's Name--------� -� -----------•--- - ---------------9-- Address '•• 'C � ---•----------------`- -f-------- - - '`�"" 47 ��`" Phone-------- i------- --------- Contractor's Name--- -------------•-------•---- -----•-----•--••--------------- ------------------------------------------------------- Installation will serve: Residence ja Apartment House [ICommercial E] Trailer Cour} ❑ Motel ❑ O#herr"❑�� I Number of baths -------- Lot size _-__-- - -. E Number of living units: ___�__ Number of bedrooms - I Water Supply: Public system El Community system El Private (_ Depth to Water Table .___-_._ ft. A r Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam Clay Loam � Clay ❑ Adobe.❑i Hardpan ❑ • No. FHA/VA: Yes ❑ Na ❑ Previous Application Made: (if yes,date---- '--- } No ❑ New Construction: Yes ❑ � &A a�fa. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well------___________Distance from foundation-_._-___-_-_______.Material-_____-__F--------------- --------------------- - ❑ No. of compartments--------- -------S•ize--------------------------------Liquid depth--------------------- - Capacity - i r) t Distance to nearest lot line------------------ -- Distance from foundation_.__._1---------- Dis o I Field: Distance from nearest well__-::"�a- Q� .Width oftrench---------�-'--------------•- G Number of lin Length of each line_________--�_--- -- �t ��ype of filter material-_ �-------Depth of filter matenal_______________________Total length______-----�--- --- 7 Seepage Pit: Distance to nearest well---.___--__. .___-Distance from foundation--------_-----------Distance to nearest lot line-----------.----- 0 Number of pits--- --------- ------Lining material-------- -------- ---Size: Diameter -------- -------- Depth--------------------------------- � Cesspool: Distance from nearest well----------------- from foundation------------------_Lining materiel'- .--------------------- ❑ ---Depth------------------------- Liquid Capact gals. Size: C}iamater-------------------------- ------- Privy: Distance from nearest we1L_-___.____---------------- Distance from nearest building____-__.__---------------------- ❑ Distance to nearest lot line.- �' ------- - ------- Remodeling and/or repairing (describe)--------------------------=------------------------------ -------A_--------•--- --------------------------- -------------------------------------------------------- ---------- p = == `-' ---4 ----#------=------------------------------------------------------------------------------------- ------ -------------------------------------------- ------- - -------- -------- -- - ------- 1 hereby certify that I have prepared this application and that#hetwork will be done in accordance with Soh Joaquin oun y ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) 5i ned JL ` Title Plot plan, showingsize of-lot, location of.system-in relation.to.wells, buildings,_---____ a --- - ( _la_--_...o - B -----�- Idings, etc.;,can.be, laced on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ DATE------- - -- ---1----7------ ----a----------- REVIEWEDBY------------------------------------ ------ ------ ®✓ ----- DATE BUILDINGPERMIT ISSUED------- --------- --------------------------------------------—------------ Alterations and/or recompIn ations: -------------- ---------- -- - ----- bhE----- ,f/�"�----- - A'Z�.i �i_� = �1-� ,�E 'y----------- -----------G p £ r �1-��- -------- ------------------------------------------------- ----------------- ------------------------- ---------------------- ---------- - --- Date '� I - FINAL INSPECTION BY:.. . ------------------ 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' Lodi,California Manteca;California Tracy,California Stockton,California } }1