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FOR OFFICE USE: APPLICATION F41 ' SANITATION PERMIT Permit No. ._._l__7._ -.[. .... -- _[3;_ -/ (Complete in Duplicate) = - -.:_.- `---;-G 2� Date Issued -- `{ �- ---- - - ---- --_.--_________-- --- This Permit Expires 1 Year From Date Issued pplica nis hereby mb&4c, the San'Joaquin Local Health District for a permit to construct and install the work herei described. This application is made in compliance with County Ordinance No. 549: JOB ADDRESS AND—LOCATION--------L-40 .-./�----------------�F#"--.rf'��fame-�- Owner's Name----------- - •0 e-p•--------------------------------------------- Phone---------- ------------....------ ----------------- - Address ---------- --- ----- ----------------------------------•----------------- Contractor's Name----- -•-• -------------------------------------------- --------------•--- ---------------------------- Phone;----------'------------------------- Installation will serve: Residence Apartment House E ommercial ❑ Trailer Court ❑ Motel ❑ Other {] Number of living units:__-_.umber of bedrooms ----- _- Number of baths - Lot size _ P)(----- 3a- --------------- Water Supply: Public system [R--'Community system El Private ❑ Depth to Water Table _ ft. e �f Character of soil to a depth of 3 feet: ' Sand [] Gravel p . Sandy Loam ❑ Clay Loam ❑ Clays❑ Adobe ardpan ❑ Previous Application Made: (If yes,date- ----------------- No Ml New Construction: Yes [—o_❑ !`JPHA/VA: Yes q�-�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' 1 / Septic Ta Distance from nearest well---�---_-_Distance from foundation--/0_-.-----_-Mater�al__-- ---- ------------------.___. No. of.compartments-- ------------ �s}- Lj- Q_Liquid depth __Dis --- to nearest Capacity ... le OA2 - e---- f -----------.... Disposal ' Id: Distance from nearest well_._.�Q---Distance from foundafion__._� _------ � !g �� Total ' length---` t� --= / Number of lines---------------- ------_..-.----!Length of each line--_-_- /r�` �. Width of trench.--- -Type of filter material-,-��Y______�De th of filter material-.-.- _- f / - p � Q / ..D�s.tance:.to..neares�t-�.-�-, - ----- pag it: Distance to nearest.well,: „f..-A.istamn e fou dation__-�_.,.._.._.. line----- -------- See Number f pits_-tc_ ,,} ---------Lining material---- Size: Diameter_. _3.��. D'e t ------------ --------- F? � g p f ; Cesspool: Distance from nearest well-----------------Distance from foundation-_-__.- --Lining material------------�.-----.---------.-- El Size: Dia eters--- 4- -------------------------Depth------ --------------- ------- --- -- ---- --------Liquid Capa city- -----------------'-----:...gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-------------------------------- ❑ Distance to nearest lot line-- --- ------------------------------------------------------------ ------------------------------------------------------ i � p ✓M�1� } � 1 Remodeling and/or repairing (describe)=---------------- - - - --------------------- k --------------•-------------------------------=--..:.------.------ -------------------------------------------------------------------------,---------------------- ----------------------------------- t _ -------- -- ---------------------- ---------------- M ,.._ �.�-v' # I hereby certify that I have prepared this application and That.,the work will be Clone in accordance with San Joaquin County ' ordinances, Stat ws, and-.Isrons of;the San JoagJn Local Health Djsfrict. (Signed}------------- - --- -` -- -- -------------------.----- Owner and or Contractor -------------------- ( / I By:------------------------------ . -(rtle(Plot plan, showing size of loem in relation= to w�Ru-ildings, etc—can beiplaced on reverse side}. i I , ' FOR DEPARTMENT USE ONLY r - . `'---------------------- ------------ ----- DATE APPLICATION ACCEPTED; BYE ---- ---= - � {' � --,' --6 ---------------- REVIEWED BY---------------------- --------------- � -------- ----- DATE-----------=- ' - --- - --- -- ----- � ----'-'-------------------------------------- BUILDING PERMIT ISSUED ---------------------------------------- -- '------------- DATE -------------- Alterations and/or recommendationss..-.. -------------------------------------------- - ---------------- --- ------------ ----- --------------------- -------- .4 f - fie `"` `.,-''- ---- - r �(.c �� ------..... --f:_ ''t�- `- �'T Y �`'�''!` `_ _ ----------- ------- ---- FINAL INSPECTION BY: M .r ( Date--..... �/- -.- ,... A -- ---- --- -- -- - SAN Jeo� AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocklon,California Lodi,California Manteca,California Tracy,61ifurnia CS 9 REVISED D-59 3M 3-%3 F.P.00. _ may.