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r FOR OFFICE USE: = 14 `] 3)" -`l Permit No. -.� 4-- ---`----- APPLICATI& FOR SANITATION PERMIT _ I i (Complete in Duplicate) Date issued ---------7_.--�---- 1_4 -0-- `------fie`'` --` -' his Permit Expires 1 Year From Date issued Application is hereb made -----------------•------- to the San Joaquin Local Health District for a permit to construct and install the work herein descri e . This application is made in compliance with County Ordinance No. 549. _.� JOB ADDRESS AND LOCATION y ------- ------- •-------------- Owne y Phone__} Q.� .�. --- - ,,s�� -----•-- ---- r,s Name------17,1_1- s---•------ _.. t---------------------------------------------------------- �Y Yom." Address._______ __• ___-.-- - -: ' - Phone./-/, ----------------- Contractor's Name---------- ' --- .. Installation wiN serve: Residence Q' Apartment House ❑ Commercial�0 Trailer Court ❑ Motel ❑ Other ❑ f " `_�x_./_ `---------------•- Number of living units: __-/___ Number of bedrooms __ Nurxiber of baths __�-"-- Lot size __.______ - i Water'Supply: Public system F ' Community system ❑ >Private E] Dep}h to Water Table ______-- ft. t ❑ y Adobe ardpan C1 Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam El Clay Loam No ❑FHA/VA: Yes Previous Application Made: (if ye ❑ No ❑ s date.__._--_.. E]) No F�- New Construction: Yes TYPE OF INSTALLATION, AND SPECIFICATIONS: , (No septic tank or cesspool permitted if-public sewer-is,available within 200 feet.) i Se ti Tank: Distance from nearest well_________________Distance from foundation____._._•---._-----Material____.______.__- -__ _ --_-------------------- nearest --_ - ---.: „p F: Liquid depth----------- --------------Capacity No. of compartments----------"..------- ---Size--�---•-------- ------------ �1 Dispos�ld . Distance from nearest well__ 4_`i=Distance from found trench Distance to nearest lot line__S___---"-"--- ` S Number of lines Length of each line "Z= ,� Width of #rench Y'` T e a# filter material___��_��____---Depth of filter-matenal_.___�d_.-________Total length-_____Z0-------------------------- p g f. s Distance to nearest well__IlfCo_;ti" " -Distance from found ation---LV_.___..__.Distance to nearest lot line-47- U, 1 5ee❑a)e Pit: Dis'a ber of pits-__.___I__-_..__..__Lining material___— -k-----Size: Diameter"-.___ _ -.--- p Numb Cesspool: Distance from nearest well_______._______-bistance from foundation..............'____.Lining materia4___________________-__.________._____. _-Depth_------------------------------------ -------------Liquid Capacity- --------------------------gals. ., ❑ Size: Diameter--------------------------------- ---------- -------- ---- ---- --- 1 Privy: t' Distance from nearest well--------------------------------------------- --Distance from nearest building-------------------------------=---------- ❑ ' ; ------------------------------- =------------------ ---- �S Distance to nearest of ine______________._-____ IF a ------. ---------------I--------- ------------------•----------------------=-- ------ Remodeling and/or repairing (describe):_------------ -{ -------••-----•---- - ---------------------------- -----------•-------------------------- ----------- ----------- I ------------- --------------- Pp hereby certify that I have prepared this a licatio San Joaquin the L o it------------------------------------------------------------ - - --i'n - c o San ui n 1 _______________________________________ ---------------_----------------------- rk will be done in accordance with San Joaquin County ordinances, State laws,!and rules and regulations of the q l Health District: i ___"(Owner and/or Contractor) ( �9 - l ------- By:•---------------�`r.- - (Title) - } (Plot plan, showing size kof,lot, location.of.,system,in relation,to,w ells,..buildings,.etc.,.can.be`,placed on reverse side). i FOR DEPARTMENT USE ONLY t ---- DATE-- -�-�--- -------------------------- APPLICATION ACCEPTED B- `------------------- ---------- ! BUILDING PERMIT ISSUED-------------------- -------------------------------------------------------- ---------------------- DATE.--------- ---------- REVIEWED BY----------------------------------- ---------- ----- DA ----------------------------------------------------- ------•----------------------•--------------------------------------- c ------------- . :_ 1 f = - - _ - era ions and/or r ------------------------------------------------------------ ------------------ ----------------------------- } �. ----- ;e it - --------------------- ----------FINAL INSPECTIONBY:-_.-""-_--- . --•-- . {--- ----------- , Date------- �+ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 Wes!9th Street - Stocklon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED-8-5'9 3M 3-'63 F.P.00. - S �- "