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FOR OFFICE USE: ,�, -- --- AN APPLICATION FOR SANITATION PERMIT Permit No. •••--------•------ (Complete in Duplicate) Date Issued/* "f-'SJ-•�7 -"----- "" This Permit Ex ires I.Year From Date Issued Application is hereby made to the San . pp y 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 SQ �CJ %// --------------------- -------- � JOB ADDRESS AND LOCATION__ -------- Phone Phone------------------------------------ Owner's ---•---------------------------••--Owner s Name"__ ._____ --- --------- ------ - Address------- !. -- --•------ - f ,rc�-� Phone Contractor's Name______ J -- -- Installation will serve: Residence El Apartment Apartment House Commercial railer, Court E] Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths'R_-" _ Water Supply: Public system 11 El system ElPrivateo Depth to Water Table .+raft- Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe[1]�-Iardpan ❑ Character of soil to a depth of 3 feet: d Sand ❑ ❑ y FHA/VA: Yes ❑ No ❑ Previous Application Made: (If Yes,dome- - ------------------I No ©/New Construction: Yes 9--'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 57 ---- ------•-------------- Septic Tank: Distance from nearest well :-`---t'/-Distance from foundation_"" Capacity-,-U-0�"�-- No. of compartments_.. Size_y f , _�------Liquid depth_____ .Disposal Field: Distance from nearest well- ----------Distance from foundation_ �Q�------Distance to nearest lot line""lS-----•-- Length of each line__. -----7 yWidth of trench-------. -�`-r-- S\ of lines--___"_G7�---------- Number , g i� ( { t otal length Type of filter ma- --Depth��--.Depth of filter materia _ _ `^ 1 l V� Seepage Pit: Distance to nearest'well-/ Distance f foundation--/ to nearest I i .._--_-_.. -- 1� Number of pits-------- ---------Lining material__ -- Size: Diameter--- � p ' ❑ Lining material-- ----------------------------------- Cesspool: Distance from nearest well___._____.____-Distance from foundation _ ___Liquid Capacity ____._gals. I Depth------ ------`-------- ------------------------ Size: Diameter. � i I -- -- Distance from nearest building------- ---------------------- ---- ------ Privy: r Distance from nearest well------ ------------ ------------------------------ -- - ❑ � -------- ----------- Distance to nearest •ot. ine-.._--.--".------------- Remodeling and/or repairing (describe :__-. ---------------------------- ---- -------------------- . -------- ------------------------------------------------ ---------------------------------- - --------- ----------------------------------------------- ------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules an a lations of the n Joaquin'Local Health District. --- {O er and/or Contractor) ------ --------- ----------- (Signed) `r7ill (Title) BY:--- ----------------------------------- -------- ------ - -- -------- -- (Plot plan, showing size of lot, location of system in relation to wells, . ildings, etc., can be pla ed on reverse side). FOR DEPARTMENT USE ONLY JI �� -- ---------- DATE- ---- APPLICATION ACCEPTED BY-------------------------�-- -" DATE = l REVIEWED BY---- -------------------------- ---------------------------------- _n------'--------- -: ---1 - DATE- ------------------- BUILDING ------------------- BUILDING PERMIT ISSUED------------- ------------- -- ----------- ------------------------------------------------------------------------ -- Alterations and/or recommendations:____"___/ �y�'7- )-"�" 1""" __-______________________ -------------------- -- ------------------ :---- --------------------------- ------------------------------ ------ ---------------------- -------- -- �j /�/ -•� FINAL INSPECTION#BY:.------k ` -" ----- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 124$ycamore Street 205 West 9th Street 1601 E.Hasellon Ave. 300 Wast Oak Street California Lodi,California Manteca,California ?racy, Stockton,California F.P.CD-