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FOR OFFICE USE: - - ------------ == APPLICATION FOR SANITATION PERMIT Permit No. . � --------------------------------__._�._ (Complete-in Duplicate) p Date Issued ------------ --. This Permit Expires 1 Year From Date Issued --- 1-�� 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. 55499. JOB ADDRESS AND LOCATION------------- - RS ._r "�-� I WCLtgi Owner's Name-------- -' } ----�-Q. __P-- &------------------ ---- --------------------- --------------- - Phone------------------------------------ 73 Address--------------------- --- __46-- ---------- Contractor's Name----------- --- -- -- ------- ------------------------ ------------------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Er Trailer Coyrt ❑ Motel ❑ Other ❑ Number of living units: -- ----- Number of bedrooms -____-.- Number of bath S- o size ----0-APe_--x--07-.7:$7 0- ---------------- Water Supply: Public system Community system ❑ Private El Dep't'h to Water Table _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ '� Previous Application Made: {If yes,date----------------- Nox New Construction: Yesx No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted iflueD lic sewer is available within 200 feet.) � �� Septic Tank: 'Distance from nearest well --__---Distancefrom foundation__/�___�--_.__ Material - --�'�'___------____________________ __ \No. of compartments--.----CRL-._-----_--Size-- __Liquid depth------- / _- Ca acit f+�0— p Y �/ sposal Field: `Distance from nearest well9 ._Distance from foundation--x.49.©-.--...Distance to nearest lot line---Sj --- Number of lines ._._..__- ----------Length of each line__747.---. ' _-..Width of french...... ----_ _ __ Type of filter material S._�v.4/P_Depth of filter material...yl _ ---.Total length---..- --------------------------- [� X7, See ge Pit: Distance to nearest wsll--- ---- ---------Distancs am f uin ation---- -_-I__-- Distar�se to nearest lot line__.-5_._+....... Number of pits--- -�`.----------Lining material-- � -- Size: Diameter:-.3_3------- --Depth-.-.sr -- -R--------------- 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) __4_4,t_0-------•------------------------------------------------ - ---------- ------------- ----------- ------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andpregulations of the,San Joaquin Local Health District. P(Signed} t --,Contractor) ---- --- ---- - ---- --- - tort e By:-------------------------------- ----------------- - (Title)-- i Title (Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- _.- ..�.._-.-1II'Z REVIEWEDBY------ ------------------------------------ ----- ------------------------------------------------------------------------- DATE-------- -----------•--•------------------------------------ BUILDING PERMIT ISSUED-------- -- ------------------ --- ----------------------------------------------------------------- DATE - Altera?Fions and/or r`��mmenda ions: rut - -- - ----- � -rte. -. - ------ FINAL ---FINAL INSPECTION BY:...........-. ------ ._. Date- =� . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911h Street Slockfan,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press