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FOR OFFICE USE: ----------- ! Permit No. o APPLICATION FOR SANITATION PERM -----_--- ---_- (Complete in Duplicate) Date Issued -//-=-= U--�� ► _------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to 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 No. 549.,► Y �� Et _ . >a JOB ADDRESS AND LOCATION---- I--------------------- �"G = -------- ---------- -- --------- __KPhone Owner's Name �Q -�------•--------- f _ Z_ `f-------------•--------- / Phone. ZContractor's Name--------- Z- � -� �C/"V- Installation will serve: Residence R_X_Partment House ❑. Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ Number of living units: __j-_.- Number of bedrooms _S---- Number of--baths ;I--- Lot size ------ -y ---------------------•- Water Supply: Public system ❑S Community system ❑ Private epth to Water Table a ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sand .-Loam ❑ Clay Loam ❑ Olay ❑ Adobe ardpan ❑ Previous Application Made: (If yes date....... ............l No �w Construction: Yes Deo L� FHA/VA. Yes �o ❑ F� TYPE OF INSTALLATION AND SPECIFICATIONS: +• (No septic tank or cesspool-permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well--- ----_Distance from foundation_./ -----------Material-.-__ No. of compartments---------Z-----------Size---------- ---------------------Liquid depth--------------------------Capacity...... 5---- -- Distance to nearest lot line--- -_-----. Disposal field: Distance from nearest well Lr -- Distance from found �- ' �p-- v s Width of french_...`. ---------------- l Number of lines------------- - _ Length of each line__-_ __ __ _.__. A- - i/ i Type of filter, material_, -Depth of filter5material____f9:_____:..-Tota4 length__.__-+ --- � : ) Seepage 1'i Distance to nearest well-__f.. -___-._,Distance fro f" ndation._ZIL�_.._____.Distance to nearest lot iine__lS-__.._..._ Number of pits '!.21__._:_-----Lining material-,S -Size: Dib meter_�xG____.-----Depth_--.-/ `--------------------- {, I I Cesspool: Distance from- nearest well-----------------Distance from foundation ---------------. Lining --. material -----.-..__ ------------- s.-. J a acit ' El Size: Diameter--- ---------- ---------- =------Depth--i- ---------- ------- --�--------------�Liquid q �id CP Y--------- -----------_.----gal Privy: Distance from nearest well------- __,_._. ---------- ------------ -'_Distance from nearesf1building----------------------------------------- . .,� ❑ --- ----- z_ '----------------------- ------------------------------ Distance to nearest of fine________________________ - , r Remodeling and/or repairing (describe)----------------------------------- --`� f ------------------------------------------------------------------- t ------ t- ------,--- ----------------------------------------------------------------------- -----------------------••------ -----------------•-------------------------------------.-------- ; r - .- � ----------- ------- -- -----•-•--------------------------------------------------------------------------------- ______________________________________ _____ __ ______ l = --------------------------------------------------------------- I hereby certify that I have prepared this application and that the work�4rill�be done in accordance with San Joaquin County ordinances. State la and rul nd reg uiations of the San Joaquin Local Health District. -�. ..---.._.(Owner and/or Contractor) (Signed) BY--- = - ------ ' -----------(Title)------------------ ------- --------- (Plot plan, showing size of lot, location system in .relation to weld buildings, etc., an be placed on reverse side]. i FOR DEPARTMENT USE ONLY KI APPLICATION ACCEPTED BY J DATE �r� � . -- -- -- --- ------ REVIEWEDBY-------------------------- ---------- --- ------------------------- ----------------------- BUILDING PERMIT ISSUED---- _ DATE - t Alt ation and/or recommen tions: a--- f G - ------------------- ---- --------=---------------------------------------------------- ---------------------------- - ----------------- -4°_________________________________ // 3 ate_ FINAL INSPECTION BY:...14L .-_- � - Date-.--- - --------------- SAN JOAQUIN LO AL HEALTH DISTRICT 1401 E.Ho:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California �n F.P.CO.