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FOR OFFICE USE; j.Ar APPLICATION FOR SANITATION PERMI .............. ........... ................. (Complete- in Duplicate) �� (a -------------- ---------------- - -------------- This Permit Expires 1 Year From Date Issued Application hereby made to the San Joaquin Local Health District for a permit to construct End install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND)�C Tir /C_20;?._0 ------- ...... `_--�-----.------------------ Owner's Name--- :... Phontie?-_-.�Q� Address ame---- Address........................... ...... - ---------------- t ............ ........... I .......................................................... I ............... Contractor's Name -------------- __50,A).$ ............................... Installation will serve: Residence Apartment House E] Commercial [j Trailer Court [j Motel [:I Other ❑ Number of living units: Number of bedrooms _Z Number of baths. j.... Lot size - t ----- --- .. ................................ Water Supply: Public system ❑ Community system Ej Private x Depth to Water Table ft Character of soil to a depth of 3 feet- Sand E] Gravel [-] Sandy Loam E]. Cjay LoamK... Clay 0. Adobe [] Hardpan 0 Previous Application Made: Ilf yes, date ................... 1 No $4 Now Construction: Yes [] No)k FHA/VA, Yes E] No>Q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within'.200 feet.) Septic Tank: Distance from neareste 0 ......... Distance from foundation........ .MaterNo. of compartmen ts. ................. Size..3A.1,KI57�.— Liquid Ldepth_"SZ . ... ........ capacity.. a;As Ve a iczn.. Disposal Field:. Distance from neo t .... ...Distance from found f- A -3., --_._-Distance to nearest lot line,1j9..,_, Number of lines ... Lengfk of each line-. ----- Width of trench ... �3!41t 11 Type of filter material._. ... Depth of filter material.... .._:------Total length ......... .. . . ... . Seepage Pit: Distance to nearest well ......................Distance from foundation -------------- .--.--.Distance to nearest lot fine.........._.._.__ El Number of pits ... .................. Lining material ...................... Size: Diameter ....................... Depth__...............___.____...._... Cesspool: Distance from nearest well ................ Distance from I foundation -------------- _ ..Lining material..._.. I .............. Size: Diameter - -- --------- ----- --- __ ......... Depth--, ... ............................................... Liquid Capacity ....... .................... gals. Privy: Distance from nearest well ......... ....................................... Distance from nearest building ............ ------ 11 .......... Distance to nearest lot line .!.-,, ... . .. ..........................-------- Remod" and/or repairing (describe):......__.___ ....... I ---------------- ---------- _ ------- --------- ......... .....--------•--•--.......... - --------- -- I --- ----- -- . ............. ...................... .................. .. . ...... .............................................................................. ------------------------- ............................ WWI --- .......... . .... I ... ... . . . ........................... - - --- - ---------- .__ - - - �- -_----------------------- ----------_----- I hereby certify that I he epared this ap 'Xication and that +h work 11 be done in accordance with San Joaquin County ordinances. ances, State laws, and les nd regulation 0 the San Ooaquin the e n Health District. (Signed) .............. .......... ...... .... -- ---- ------ - ... .... ------ r.1 ... . .... ........ (Owner and/or Contractor) 6 �syst rin s ....... By:__ ...................... k_ . .... ... ...... ........ I .......... . .............. (Plot�plan, showing size10 ocaflon of system in relation to wells, buildings, efc., can 6 place an reverse side). .. .... -- -- -------- ------ ----- - --- --- of a e Pon reverse FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_'.N.,t',2� -P,__ — REVIEWEDBY., -- - ---------------- .............. W -------- - ----------------------------------- DATF_(_1 . ..................... ................... ........... ---------------------------- -- --1 .................. DATE.---....--.----------.-------- ----------------------------- BUI'DING DING PERMIT ISSUED ........ .. ..... ------------- .............................. . .................... ................ DATE ..... ......-- - _ Altations and/or recarnmendaflons.._ . .--------------------------------------- ---------- ....... ................ ------------------------------------ -------------------------------------- ................................................... .............................. ............ ... __ .......... I ............ 7 -- ---------- --- ----- ---- --------- -- --- ----- --- _- - _- - --- - . ....................................................................................... ...... . . ......................................... - I ............... ------------- ............... ..... . . . . . . . ----- - - I....., ................ ...... ----------- ...................... ............................. .... ........... I ................ . ........................................................... ..... ............................................ --------_........._I .................. , -------------------------- .................. ............... FINAL INSPECTION BY:..,,,-, .... ................... Date ........... .............. ..... ..................... SAN JOA9UIN LOCAL HEALTH DISTRICT 1601 E. Ma"llom Ave. 300 West Oak Street 124 Sycamore Street 205 Wert 9th Street Slecklon, California Lodi. California Manteca, California E.H. 9 2M 1.67 Vanguard Press Tracy, California 1