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.� Permit No. APPLICATION FOR SANITATION PERMIT �-Q� ��`,I �, �• i� (Complete in Duplicate) Date Issued "Ajy-?--- Application is hereby made to'ithe San Joaquin Local Health District for a permit to construct and 'install z work herein described. This application is made in compliance with ounty Ordinance No. 549. 7 JOB ADDRESS AND LOCATI,O ----- --------------------------- --------------------------------------- n e------------------------------------ Owner s Name---------- ---•----- ------ � A Address---------- ------�- --------- ------ ----------•-------------------•--------------one----------------------------- Address ---- ------------------ ------- --- ------------------------------------------------ -------- Ph ----------------------- Contractor's ame_____________________ _ __ _ -- ----------- -- Installation will serve: Residence [�'°�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � ` ! /� ------------------------- .'--/---- --------- Number of baths ,c-�_ Lot size ,/� !'�- - - -------- ---- ! Number of living units:pl__�__-- Number of bedrooms ." _ Water Supply: Public system'❑ Commuriit system Private ❑ Depth to Water Table',/o ft. Y Y "� Clay Loam Clay Adobe �ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ y ❑ y ❑ Previous Application Made: Yes ❑ No T-1New Construction: Yes El No El FHA/VA: Yes E] No F1 Ih TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'ces pool permitted if public sewer is available within 200 feet.) i . Septic Tank: Distance from nearest wel�l_y"---7---Distance tom founclaf on___��______-__.Material_ r w Ca aci No. of compartments-------e4_.-----------Size__ - �---•Liquid depth----"4 ----------- p tY--- or �49-------- Disposal field: Distance from nearest�^'ell__"�'""----.Distance from foundation___�_� - Distance dthcofttrenchnearest�lot �e"-____.__-_____. � Number of lines------ ``,,�•.Length of each line_ c � :a Type of filter material p ��00 Distance gto nearest lot line _ -- -- ---------------------- --- -------------- Distance from fo ndatloj De th of filter matenal_" Total length_ Seepag Pit: Distance�"to new well.... 10i Number of pits____-- '._.-------Lining material_ --- Size: Diameter___.�j--- -------.Depth_.__ ---- ' Cesspool: DistanceIlfrom nearest well_____--.____._-Distance from foundation------------------`Lining material_ gals. ' ❑ Size: Diemeter--------------------------------------Depth--------------------------------------------------- qing Capacity ' Distance from nearest building----------------------------------------- G Privy: Distancef from nearest well-------------------------------- Distancel.to nearest lot line----------------------------------- ❑ ------ ----------- y , l Remodeling and/or re airin describe _ _ 14, ------------•--------------------------------------•----------- l -------------------------------------- -------� --• --------------- ----•---•-----•-------------------------------------------- ---------- ---------- 1 i ! hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County I ordinance$, State laws, and rules and regulations of the San Joaquin Local Heal+h District. r Contract 0 os ------------------ (Signed)-- ----- ------------------------------------ By: -. Plot Ian, showing size of _.___.•"" -----"-----" 13y:------------------------------ buildings, etc., can be placed on reverse side). P lot, loca+ion ystem in relation to wells, FOR DEPARTMENT USE ONLY DATE------ _ ---------------------- APPLICATION ------- APPLICATION ACCEPTED BY------ - -------------------- --------------------------------------------------------- REVIEWED BY DATE------------------------------------------------------------ ------------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- A---l-t-e- rations and/ or recamm endationsP-------- ----------------------------- ------- ----------------------------------------------------------RrAT-X--------- - - ---------- -------------------- - c, iN 7l_3N-K �----- �� -"0,-K----------1 ' z�- � ,_n.� _` ------og----mss----Y�c - -- ------------------------------------------- ---- --- - - - - - - ---------------------------------------- Date Y: ----- -- -------- OFIAL INSPECTI - q SAN JOAQUIN LOCAL HEALTH DISTRICT E' F 814 North "C' Street I 300 West Oak Street 132 Sycamore Street !30 South American Stre�fi Manteca, California Tracy, California Stockton, California i. Lodi, California } E5_7-2M , Revised 1.57 FY-CO-