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FOR OFFICE USE: ------_---- __ _1 ,_06 . F -------------- . ..................... .I;a ..... APPLICATION FOR SANITATION PERMIT Permit No. l�' ............. - ------------- [CamplefC in Duplicate( Date Issued .:_-w2:n �-- .��--- --------��--�:-�'-- This Permit Ex ices 1 Year From 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 with County Ordinance No. 549. ' N,,` JOB ADDRESS AND LCATION..... r ( Owner's Name -- __-__ --------- -----•------•.---.--------------- - ---- -- Phone.............. ..................... � t Address.................... ----------------- ....-r��-'�_--------------------------------------------------------- Contractor's Name % ' ''Tr-cam �E1•. _..... Ph Installation will serve: Residence Apartment House E] Commercial Trailer Court El Motel [IOther''❑ Number of living units: _../. . Number of bedrooms ____ Number of baths .... Lot size ... �►t.. -j........................... _ z. Water Supply: Public system ❑ Community system ❑ Private J2/6epfh to Water Table _4�4_ £f. •,A7 3 !! Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam D. Clay ❑ Adobe [7 'Herdpan ❑ Previous Application Made: (If yes,date--------....--------) No New Construction, Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' 1 / Septic>,k, Distance from nearest well..+ Distance from founda�n_.. .��_.........Material........ _, . [ No. of compartlents._o' _....____..+�«Z.]5ize. _/._______._ _Liquid depth.. .- .......Capacity__ � •••_� Disposal Field: Distance from nearest well.''.5.70.. .._Distance from foundat'o _.'.:f -. l .....Distance to nearest lot line.. Number of lines---_------f�............._._....Length of each line. . . ''. e' __ / L Width of french._. a�.__.._ Type of filter mate ria L69W.ZC.+V�epth of filter material___.-/t�_._ ...Total length....... See Pit: Distance to nearest well__.. ------- from undat;on___f a.�_.. Distance;o nearest lot line--------__..- Number of its._!__.__._.. Linin material. 0 ---- / P � 9 �.Q--- --� Size: ier._�.�_ �.�2..---Depth.... ..�.hl�..----• Cesspool: Distance from nearest well.................Distance from foundation.......... .... ....Lining material......................... .-.-__-_.-_.. El P - . - . ...........Liquid Capacity--- ------...gals. ize: Diameter--------•--....-•- ..................De th.....__...-----•-•--------- - Privy: Distance from nearest well...... ...................................... .Distancitfrom nearest building..........................._____......... ❑ Distance to nearest lot line.-------------------------------- - Remodel' g and/or epa`iring (describe):......- . / 4 ---—------- -U l�_ _W7 ........... r/ e �K_. __ - - ------ ........................................................... ' ' -` -- -- ----- -- --- ------ --------- --- -- - - -- - �. hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County-- - - ordinances, State laws, and rules an regu.,641fionsfSan Joaquin Locel Health District. Si nod ; •,�,•( 9 } ----------- ------------------------ -------------------....(Owner and/or Contractor) Y BY:----................................ ............................... --- - --------(Title)--------- --------------- ----------------------------- -------------------------- •-- ---------- - - -_.....---------- (Plot plan, showing size of lot, location of system in relation to wells,-buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY ) APPLICATION ACCEPTED BY.......... ACte....---a----- ......•...••••......•.................................. DATE....•3. ._,---,.,Fn REVIEWEDBY---•--------- ---- --------------------•- - -- - •------------------!............ .... . DATE•••• . ....... --------- ------------- + BUILDING PERMIT ISSUED. ----------------• ............. ...._-------------------------------------- DATE...I...................... ....... ........... Alfer tions and/or recomme.nd.a,tions;,:............ . ...d...... . � "L/�' - •••. a. -- --- l - -- -----.__`. .� :mac ate D - - •------------------- SAN JbAQUIN.LOCAL.HEALTH DISTRICT W 1601 E.Ma:elfoa Ave. 300 West Oak Sheet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. a .