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/5rV l-l-ICb USE:k. --------- APPLICATION FOR SANITATION PERMIT Permit No. --- --- --- --- = ------ (Complete in Duplicate) This'Permit Expires ] Year FromDate Issued 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. JOB ADDRESS AND L �CATI N--- - � { " -- ------ -. -•----=- Owner's Name------ F ' "+ =: Ph------- .— Addresst --------- Phon :..Contractor's Name---- Installation will serve: Residence ------------- .ertment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number.of bedrooms _:!k",r Number if.baths"-�____ Lot size s _j-"- -'-------------------- ft. ----•----------- -- --- Water Supply: Public-system Comrrlunit system 5 k Y Y ❑ Private [] Depth to Water Table b ft. Character of soil to a depth of 3 feet: - Sand D Gravel ❑ Sandy Loam ❑ Clay Loam [ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-:i-------._._--'}Jr No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perm itted if public sewer is available within 200-fee+.) 4- Septic Tank: Distance from nearest Iwell-________________Distance from foundation-____ ___" ------Material-------------------------------------No. of compartments- _-----------------Size----------=-------- - :---Liquid depth---------------- --------1 Capacity----------- Disposa) Field: Distance from nearest eil� -s.�:,._Distance from foundation- "f-d ' • - -----.- Distance to nearest lot line____j w' Number of ijnes-_--------I---------------------- }Length of each line........3--,;- __--'_Width of trench.-------`=--y,"----- C�J�{ Type of filter material-c -'-J�cr-e .-_Depth,.of.filter material-------,- --'�--.:Total: length_=------ :- ,� —� Seepage Pit: Distance to nearest welly _". Distance r� undation__ % r r f _.-_7�_F_-___.Distance to nearest lot line____!_______.._ _ p (` : Diameter------- = j - Depth--------- a_.------------------ Cesspool: S D stance fromsnear' est:well------------Lining �Dis� rom faundat on°' � ---------------Lining material---------------------•--------------- ❑ Size: Diameter --------=-------------=-----___Depth---------- 11 1 1 ------------------ -----Liquid Capacity-.-------------------------gals. _ Privy: Distance from nearest.well__'_.__ _---,_- " "- Drstance,from. n.earost .buildin ❑ Distance to nearest lot line ._---."_ g - --------- Remodeling and/or repairing (describe):___` F - -. �. .A �- _y- -G�.- . -----------------------------------I----------------_----------------- t --------------- -------------------------------------- ------------ I hereby certify that I have prepared this application and that�the work will be done in accordance with San ordinances, State laws and rules.and regula.tions of the San Joaquin Local Health District. Joaquin Coun+y (Signed)---------------= { ------- t------- --------------------------------------------------------------- ----{Ow er and/or Contractor BY: L� - ----- - Title { ) � ) {Plot plan, showing size of lot, loaation' system in relation to`wells,.buildin s, etc. 4can be placed. f t� ,f y g paced, on reverse side}. ( FOR --------------------- :DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY------�aeo _-."-" "` 1�- ------- --------`--------"---- DATE �- IAS REVIEWED BY ----------5 - - ---------- ---------- - --_ DATE----- k BUILDING PERMIT ISSUED___.. r----- ------ t r ------------------------------ ------------ . t ------=---- DATE � -i Alterations and/or recpmmendations---- - ---- ----- ---- f 1�� • - � - --------------------- -------.-------------"------- -- "-� -!`�� -. -------------------�- = ` --------------------------------------------------------'=_ ==.` .• " ------------- ---------- ------------------------------------------ s i ------------------------ - , r = --•---- FINAL INSPECTION BY:. '�,'" _7 1� � Date ------ --------------- - ----------------------------- fLodi, California QUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, Street 124 Sycamore Street 205 West 9th Street Stockton,California Manteca,California Tracy,California ES 9 REWSED 8-59 31A 3-'63 F.P.p p,