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FOR OFFICE IUSE: a vA ........................................................ APPLICATION FOR SANITATION PERMIT Permit No. ......................................................... (Complete in Duplicatel ................ This Permit Expires i Year From Date Issued Date Issued 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 ith County Ordinance No, S49. Z(1'--p*D.- 0 JOB ADDRESS-AND.LOCATIODI_/5.---- Rte( ..._. :_......2 �Ip....---_•-•-----tit= Owner's Name.. N-R,y'...._._..__!`AF� * Add ress.............. ilr._-f.. p • l9hl_T..I:CA__: ......................................................_.. 0 ..... Contractor's Name1l`+4-_ '., v --------..... ......... Phone--- .._.. .. Installation will serve: Residence ��"`""" ` Apartment House Q Co j martial ❑' Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .--L_ Number of bedrooms 3.. Number of baths J____ Lot size ....... 31.a___X..._ 2n Water Supply: Public system ❑ Community system Q Private Depth to Water Table 6_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam QrCiay Loam Q Clay Q Adobe❑ Hardpan 0 Previous Application Made: (If yes,date....................) Nor New Construction: Yes Pj o ❑ FHA/VA: Yes ❑ No Er TYPE OF INSTALLATION AND SPECIFICATIONS: "'INo septic-tank or cesspool porm'itted if public sewer is available within 200 feet.) - �►•� Septic Tank: Distance from nearest welt-_,'C7_•-••Distan`�t from foundation__1Q............M�teri I___.__C-o;�RJET' - No. of compartments.......2------------Size-_7_.-XJ_0__K.�•Liquid depth s..•....._.Capacity._/__.Z _p___ Disposal Fid! Distance from nearest wet D__--_Distance from foundation_.__ _.Distance to nearest lot line..:57 {� [ � Number oflines------------- Length lof each line-_.V::�t.g -...Width of french_....... Z Type of filter material__. __•.-Depth of filter material.._..?__._--._.._Total length...........t� ` ?.................. {C Seepage Pit:; Distance to nearest well......................Distane.eyfrom foundation....................Distance to nearest lot line_____._.......... ElNumber of pits_--•------------------Lining material!_........." '. _`_" Size: Diameter.......................Depth......._.........-... ......... i Cesspool: Distance from nearest well.................Distance from foundation___.................L'ining.material...................................... - ti--.. El Size: Diameter.....................................:Depth.-�{------------------•--••--•-••--••---••--------._Liquid Capacity............................gals. , Privy: Distance from nearest well....-..........................!______.____._.._Distance from nearest building................_......................... ❑ Distance to nearest lot line._.. _._.. ,�y- -- •- - ................... _......... 7 all t INNA hftdan Remodeling,9;d/or repairing Idestri6el:__._5 57'€m __.4X�A,V.A.T_ -b..._._PfKj_K..-_`TQ_ ........................._..........----_I--••---•-•---••••--.... . . _ I �R>o• : - -I ---------- - -- ---- •--------------------- -- - ----•---••- ......................... ................................................. _._.---•--............................... -•----•.... ............ -------- ---•----•---- ---------------F.�_.- ----r ._.... I hereby ce4an s a prepar this application and thkat the*work will be done in accordance with San Joaquin County j ordinan s, tatu s and gulationi* of the San Joaquin,Loc'�l Health District.C(Sign d)___-- ,r ` . ........................ ...(Owner and/or Contractor) ::-=-•......• .-..- ':+i!-----^ `'. ....(Ti+le).-.w.......__.._.. .........................._--•-- (Piot plan, showing size of lot, location of system in relation to wel�s,4buildings, etc., cats-be placed on reverse side). j FOR DEPARTMENT-USE ONLY C,..--.�--- �.� -------- DATE.......... �_. ._�?fz..---------........... APPLICATION:,"ACCEP,TED,'8��,'I.'�:R.-- ,.•--- ---- .-------------------------------------- REVIEWFABY'"r ---------------------------• �•--....._._...----•...................... ............................. DATE.......... .............................................. BUILDINGPERMIT ISSUED.............................................•------•••-•----•--••-•--•---•--•_._..-------_------ DkTE............................................................ Alterations and/or recommendations:___.._.CVJWF�%T? .-._J-Y - 'Ilk T.I�.T�On(.:._A.lQt9.R............................................... ...................................... t ...-►}�+Ifif�.1 -----•-••------------------------•-•--•----•---..........----------•-------••----------------------•----..._.___..._......--------........_..------------•---..._....._...------•...........---•........................... FJNAL INSPECTION Date_............. ' t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stodden,Califomia Lodi,California Manteca,California Tracy,California F.P.CC.