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FOR OFFICE USE: -------------_---.- ----------------------------------.- t4 APPLICATION FOR SANITATION PERMIT. Permit (CO - _ --- ------------------------------- -- - . . ,,,,,.a_ --�� 6 Date Issued _�/Z - 0,pe - ----- --------- ----- ------ --- �; -This-Permif Ex •rfres 1 Year From`Date Issued / 4( p , .� made to the San Joaquin Local Health District for a 4 � F _" t ! 4 r,, Application is hereby: permit to construct ar instal the work herein described. This application is made in compliance with Count Ordinance No:'549.'p. t JOB ADDRESS A LO TION--- - - .-.----- *-.-`--� .. -:---.- ------ ---------------------------------------- �i 1 LA Owner's Name.` -r • --- :: ------------ ---- Phone----T_ -'- 2 Address-_ _.----- —--- ......... _-.�, __ -Sp._ ---------------------------- ----------- .-- - # Phone. R Contractor's.Name_._.'... ----------•------------------•------------------ ------------------------ 4 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel (] Other Elunits: _ Number of livin; e4 g � Number of bedrooms-'-.------ Numberf.of baths 4r Lot:size _--_�/a2._- - ---- ---------- ----------- Water Supply: Public system El Community system ❑ Private 9-r Depth to Water Table/tE,ft. Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam Clay Loam E] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No E] New Construction: Yes No E] FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS:, (No iepfic tank or cesspool permitted if public sewer is available within 20 feet.} '- Septic Tank: compartments Distance from nearest well-S-0--------Distance from foundation-j-4 Material--- --�- - - ------ �( Nof c To. orn i P Size.` .!,1-x s` C/ --Liquid depth Capacityy Dis osal Field: Distance from nearest welL-:90____*Distance from foundation- /U--------.Distance to nearest lot line------_----- ,N:'mber-of IinesS---------------- Length of each line//%4k--4A Gd_3QWidth of french___.-.�__, ----------- } .a.Type.of filter-mate'riaLS-t. OC4'--Depth of filter material- :___Total length-------3_-S`4---_---------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest tot❑ line----------------- of Lining material : L��-Ndmber ops-----f---------------- nng maeria----------------- --.. ze: ameer------------------------ ep ----------.---------------_- .- . : SiDiameter Depth i e Cesspool: -Distance from nearest well-----------------Distance from foundation.__----------------Lining t . materia l------.----.---.-----_.---------_-- Size: Diameter Depth- - = - � Li Liquid Capacity---- --- ---- -----•---gElall. ;rest we 1. Privy:' i'Distance to nearest lot I nle----------------- Distance from Barest building --- Remodeling and/or repairing (describe): ----------------------------------- -------- --•----------------•-------------------------------------- ------ ------------------------------------ -•--------------------•-------------------•---------------------------=--------------- ------- ----------------- ----------- - -- - --=------=--------------------------------------------- -------------- ------------------------------ ------------------------------------------------------------- -.- x_ .1. t-- --------------------------------------------------------------- ----------------- - ------------ ------------------------------• --------------------------------------------7--- I hereby rfify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, fat laws, and rules and regulations of the San Joaquin Local Health District. awn', (Signed)-- wt" *, - , -------------------------------------------- -- --(Owner and/or Contractor)1 j _ � t.c ��-,� �`�_�-_- --•- - ---- ----- ------ ___. .. --={fitle) (Plot plan, showing size of lot, location of system in relafi to wells, buildings, etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ _.--1.-!- .Q --- --------------- ------------------- -------------------- DATE--------- - REVIEWEDBY - --- - -------------: --------------------------------- ---------- DATE-------------------- BUILDING PERMIT ISSUED........'-- ------ _.- DATE------ ------------------------------ Alterations and/or recommendations:-------------- ------------------ -----------•-------------------------------------- ------•------•-•- -•----------•--------- --------------------------- FINAL INSPEC BY: , t aDate------------------- ��77l•�- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street F Lodi,California Manteca,CaliforniaStockton,California Tracy,California , ES 9 REVlSEO 8-59 3M 3-'63 P.P.ro.