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Permit No. <br />Date Issued <br />OR OFFICE USE: <br />i= <br />APPLICATION FOR SANITATION PERMIT <br />(Complete. in Duplicate) <br />This Permit Expires 1 Year From Date Issued <br />,cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />spplication is made in compliance with County Ordinance No. 549. <br />ADDRESS AND LOCATION >16 3 8' <br />Jr's Name ....Ze.fai.4.ce <br />ass -/-6 c.,41+ Pm 4' r - c4e.hr.. •L/ <br />-actor's Nome - Phone <br />lation will serve: Residence 0 Apartment House 0 Commercial fij Trailer Court 0 Motel 0 Other 0 <br />Number of living units: .. ... Number of bedrooms. . Number of baths Lot size ..00.0ic -;as7.0 <br />yr Supply: Public system tg Community system 0 Private 0 Depth to Water Table . ... ft <br />actor of soil to a depth of 3 feet. Sand 0 Gravel 0 Sandy Loam 0 Clay Loam 0 Clay 0 Adobe (2 Hardpan 12 <br />au: Application Mad*: (If yes, dote. I No ja New Construction: Yes Vi No ID FHA/VA: Yes C] <br />OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />c Tank: Distance from nearest well/.5—C.6 '.Distance from foundation 1S <br />No. of compartments ..7./ Sizes5".X,f-?‘ ...Liquid depth <br />Distance from nearest weil/St‘I Distance from foundation...,. —6" <br />Number of lines Z. Length of coch line.. ire:, r <br />Type of filter material..2t. Lt. °Depth of filter material. /5 <br />Distance <br />/ <br />foundation b <br />material .c.) k. Size: Diameter <br />Distance tom foundation . <br />Depth <br />Distance from nearest building <br /> <br />xieling and/or repairing (describe): <br />). ,(-3(..Z.„,V 2 lg. <br /> <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />lances, Sta -tors, and rules and regulations of the San Joaquin Local Health District. <br />JOwner and/or Contractor) ed) 6 <br />FOR DEPARTMENT USE ONLY <br />Phone7 3/. ... <br />isal Field: <br />age Pit: <br />1 <br />3001: <br />Distance to nearest well V-4)Q <br />Number of pits / Lining <br />Distance from nearest well. . <br />Size: Diameter <br />Distance from nearest well <br />Distance to nearest lot line <br />Material C'a <br />Capacity...PC; C <br />Distance to nearest lot line.75 <br />Width of trench. <br />Total Total length ff.i."? <br />Distance to nearest lot line,. .'9'.... <br />5.". Depth .2.-5 <br />Lining material. <br />Liquid Capacity. gals <br />.-- <br />1/ ) <br />By • . (Title) <br />plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />JCATION ACCEPTED BY <br />EWED BY <br />DING PERMIT ISSUED <br />at ions and/or recommendations: <br />AL INSPECTION BY:: <br />DATE 2-- ‘' <br />...... DATE <br /> DATE. <br />Date <br />1)1 r)`' ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1401 I Hasellon Aye. <br />Srockton, California <br />300 West Oak Street <br />Lodi California <br />124 Sycamore Street <br />Manteca, California <br />205 West 9th Street <br />Tracy, California