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FOR OFFICE USE: I f Permit No. �•s/ >.•........_.- ........ 1 APPLICATION -FOR 'SANITATION PERMIT i ......... -•'................ ......... .. (Complete in Duplicate} Date Issued _ 7 _ .._____- _,• This Permit Expires 1 Year From Date issue I Application is hereby made to the San Joaquin Local Health District or a permit to construct and install the work hereiescr This application is-ma a in mpli ce unt d' nce N DREss-ANLDTiON._. .. _..SN '?► -f''-��f'�---- .. �7W. --------------------- L JOB AQ Phone-------_--•-----.-------......... <_1 t ................ ,tip.tri. J:..... Owner's Name.....,.�tt1N.t'__ /�......---- .... ....---•--•.............••-. - Address......T11.1_ .. Q j p Phone.��.b.R. ..I r ` i X2._7.-1 C -----5`�Y-V..l. G------------------ -- Contractor's Name.._" -'-�'-J•--•-• • �/ ! , r Trailer Court ❑ Motel �} Other ❑ Installation will serve: Residence (]'"Apartment House ❑ Commercial ❑ Number of living units: .----- Number of bedrooms -.,3-._: Number of baths I--.._ Lot size ��-��• �' � '•"..................•. N Water Supply: Public system ❑ Community system ❑ Private E Depth to Water Table Clay C] Adobe❑ Hardpan Gravel Sand Loam ❑ Clay Loam Clay,'. Character of soil to a depth of 3 feet: Sand ®' ❑ Y FHA/V1{� Yes�" Na❑ - '' Previous Application Made: (If yes'dole.-.................� No [� New Construction: Yes Ki- No ❑ # TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)` i Ca acit 1.L_ --.. . Septic Tank: Distance from nearest we11..,�4.....___.Distance from foundation...................Materia.. No. of compartments-.---.2..--•-.•---••-----Size••5.(.-5C• -K.��-Ligwd depth__.._-y......._ P Y I Disposal Field: Qistance from nearest weii..> o- .- Distance from foundntion.../.A'.�........Distance to nearest lot lin .............. . Number of lines.------�..--•---•-- Length of each line...;__.QQ-�•_.•.; Width of trench.... --•--- T Type or filter material._..trhQ_G.��..-_..Depth of filter materlal...1f.............Total length...._...L�- - 1 y Distance to nearest lot line__..-.-....__..t Seepage Pit: Distance to nearest well......................Distance from foundation -.--..__.--..-------.--•-•----•-- ❑ Number of pits......................Lining material_......_.-.-.-..-.---.-Size: Diameter................ Depth Cesspool: Distance from nearest well.................Distance from foundation....-..._.._..•......Lining material a acity --------•-- --gals. ❑ Size: Diameter----.--------•-•---....._---•-------.-Depth---------------------•-•-- - - Distance from nearest building------------------------- --• ••••---••- Privy: Distance from nearest well.__;--•--------------------- .......................... Distance to nearest lot line............. .......----••..... .........____.... Remodeling and/or repairing (describe):-----------.......................................................................................... .......... •••••-••-•.................•--•-•--•------...--•---•----•---••-•••.......... ................•- • ----••.-...._....._I..--•---••-•-- ....--•••---••-..... ..........................................huity I I hereby certify that I have prepared this application and that the work wif! be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _----__-• -• -._.(Owner and/or Contract lSi ned -- .. .. .........-rte.. -....-----•-•--------------••-------•-- ............... ..............................................................(Titl --- P (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side. F R DEPARTMENT USE ONLY } APPLICATION ACCEPTED BY.------ - - •l.G- ......................................... DATE.. .. '=T.(e..7_........... ------------- DATE.-..-...--------------------------- - REVIEWEDBY........-----------.•------.--------------.-...----• -. _.......----- --•--••--•--------•--- --------------------------------------------------------- BUILDING PERMIT ISSUE -----•-•---•---.._...-•----•- ---------------•-----------•-• Alterations and/or recommendations:---------.......... ....................... .............................................................. ..........I............................. Date....--•-- � F = ...... ------------------------••---- FINAL INSPECTION BY:............_ ., SAN J AQUIN LOCAL HEALTH DISTRICT 124 sycamore Street 205 West 9th Street 1601 E.Melton Ave. 300 West Oak Street Tracy,California Stockton,California Lodi,California Manteca,California F.P.0(3.