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FOR OFFICE USE: .s� - 2?3jJ01 Permit No. - -�----------- ---L `•� •��, APPLICATION FSPERMIT - R SANITATION ---------- --- --------- _ -- licate(Complete in Duplicate) Date Issued �----`-•-------- -------------------- ------------- - - ----- - =I3--- -_.- This Permit Expires 1 Year From Date Issued ----- ------ ------- work herein described. Application is herebymade to"the San Joaquin Local Health District for a permit to construct and install the This application is made in compliance with County Ordinance No. 549. ' JOB ADDRESS AND LOCATION--------- ------"-- " Phone77 Owner's Name------------- ---------- ------------------------------------------------- �C --•----- ---------------------------------- Address--- ---------- - • moi/�� Phone.. ---------•-------•------ ------- Contractor's Name---------------- ------- ----------• --- I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 0- Number of baths ------------------------- Number of living units: __�" Number of bedrooms __ - ._ Lot.size .___- .-- 'p-� Water Supply: Public system [�t"C ommunifiy{system ❑ Private ❑ Depth to Water Table -�ft. %s Sandy Loam Elpan Character of soil to a depth of 3 feet: Sand ❑ Gravel C] --New Yes[ ❑ lay F] Adobe rd No [I[]�FHA/VA: Yes No ❑ Previous Application Made: (If yes,date-----------------•--) No [t�New Constructs ❑ TYPE OF INSTALLATION AND SPEC IFICATIONS: . (No septic tank or cesspool permitted if public sewer is available within.200 feet.) # k-,nDistance from nearest well-_�"" -"- --Distance from foundation__________________.Material___.____...__...____..____.------------- ------ F No. of compartments- Size--------------------------------Liquid depth--------------------------Capacity--------------------- Id: Distance from nearest well________________Distance from foundation___.___..__________.Distance to nearest lot line______-_______._. Number of lines-----------------------------------Length of each line------------------------------Width of trench.------------:------- ------ Type af;filter- material ___.------------------- Depth of filter material-----------------------Total length-----------------=------- Seepage Pit: Distance to nearest well __...___._____._ _ istance from fo ndation----'? ._..__.Distance�to nearest lot line_. d------ Size: Diameter._.__33---------Depth--.--OZ_�r/AQpr� ❑I Numberiof pits-----!----------------Lining material`��__ - ' Cesspool: Distance from nearest well______.___-_..__Distance from foundation................... Lining material--------------------.___.----------- Cesspool: -_. _.-- Li Liquid Capacity_ gals. ElSize: Diameter----- ----------------- --- ---- :Depth------- ° -------- -------- --------- -------- - 9 p Y- ------------------- ---- Privy: Distance from nearest well-___.-________________-_-__ _----------- --Distance from nearest building.-------------------------•-------- ----- Qistance to nearest lot ine--------------------�------- ----------------- ------------------------------- E r ____________________________._--____-_____-___.___._____--_____--__--_____--____-_ ___________________________ Remodeling and/or repairing (describe): - ' ---------------------------------------------- ------------------------------------- ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and regul ons of the San Jo quin Local Health District. � -------------------------------------- (Signed) ------- -- r and/or Contractor) (St ned _ �9 - ---- ------- ------ (Tit! ---------- ----------------- By: -------- --- -------------------------------- -- - - ----- -- ------------ e)- -- - - ------ - --- -- (Plot plan, showing size of lot, location of system in relation to w Is, buildings, etc., can be p1 a on reverse st side). FOR DEPARTMENT USE ONLY - - - DATE---------f-L---�f-- ----(°F-�----------------- APPLICATION ACCEPTED BY------------ -- - - ---- ------- -------- ------------------------------------------------ " DATE------------------------------------------ --------------- REVIEWEDBY------------------------- ------------ --------------- ------------------- ----------------------------------- --- DATE- - --- BUILDING PERMIT ISSUED-------•------------- ------ F Alterations and/or recommendations:------ __ .L- -- - --- �- f -----------I---------------------------- ..........---------- - FINAL INSPECTION BY -`. ----- --- = ----- Date---------- ---------- ---- -------------- --- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 91h Street - 1601 1601 E.Haselton Ave. Lodi,California �I Manteca,California Tracy,California Stockton,California + F.P.CP.