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FOR OFFICE USE. --------------------------------------------------------- APPLICATION )R SANITATION PERMIT Permit No. .. ----------------- ------------------------------ -------- (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued Dete Issued .-_-___--- Application is hereby made 2 B4-2c{b -OS to the San Joaquin Local Health District for a permit to construct and install the work herein described. This is'_Made in compliance with County Ordinance No. 549. --� � 07" CU f. t�-.SpPii{o-cation..j.3�;5�� %mac � � •.� r JOB ADDRESS A �--%4-�=cOCATION-_ ' Owners Name----_-- ___ fi •-- -- -- ---------------------- ----- --------------- Phone Address-------------- '... &---C4-4- ---.- � . ---- - i Contractor's Nams_ . .CL l+l- ��f �. 1 r_`e..�....-__---------- •------ Phone.._?�...�_,��r-1 r. i Installation will serve: Residence gi-"Apartment House'❑ Commercial ❑ Trailer' Court El Motel I—] Other /- ❑ �� Number of living units: -- -- Number of bedrooms -.�Numbe.r of baths _ k-Lot.size ___- �_0----_.7C_f.Z .............. Water Supply: Public system ❑ Community system ❑ Private�Depth TO Water Table ------ ft. y W Character of soil to a depth of 3 feet: Sand ❑ Graver Sandy Loam ❑ Clay Loam�VNo lay ❑ Adobe❑ Hardp 0 Previous Application Made: (If yes,date-------------------- No New Construction: Yes ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 10 0 {No:septic tank or cesspool pbrmiffed if public sewer is-availablewithin 200 feet Septic Tank: Distance from nearest well-_-------Distance 'rom foundption___ .- - 0----- -.Ma enal-- n----- . .... .... - No. of compartments....Z---: ---._S7 _ r ` P Riquid depth- ----Ca acl r ,. --- Disposal Field: Distance from neares well__4Q- ____Distance from foundatio .-. 1�-. .--_-Distance to nearest lot line.--- _..._ Number of lines--, ------_ Length o h li ` << �� E hof trench-ca -7`- -------•---- -Type°of filter material:�� - _--:Depth2of'tilfer erial_--__ - -�f_--_-Total length--•-- _- f o Seepage pit: Distance to nearest well__---.__-.__r _-_Distance from foundation-------------•___-_Distance to nearest lot line..... -_----.-.... ` 1 ❑ Number of pits---------------`--.__Lining material----------------------- Diameter------------------------Depth--------------------------------- Cesspool: ------•-_---_-----•---- Cesspool: i Distance from nearest well_----------------Distance from foundation---.------.---------Lining material.---.- ❑ -------------- ---------------- size: Diameter-------------- ------Depth----------------------- •--------Liquid Ca aciYX.--%- I ---;------•------- --gal 1 Privy: Distance from nearest well-----_--_---'.-__-------------------------------Distance from nearest building ❑ Distance to nearest lot line-----` Remodeling and/or repairing (describe)---------------------------------- --- \ I hereby cerfi that I have prepared this applicat- n and that the work will b one in accordance with San Joaquin County ordinances, S s/� d rules a r ions of a SaJoa ' eal istrict. J' (Signs�_ By:------------------------------------•---------- ------- ----- ___ __ - -------ITi+le} [Plot plan showing size of lot, locatibri of system`in relaf- - o wells, building fc., can be placed`on•reverse side). - m FOR PARTMENT USE ONL APPLICATION ACCEPTED BY---- - - -af DATE -r -- &:W- --------------- REVIEWED BY ---------------------------------------- --------------- -----.. DATE ----••------------------- ----------- -----------••----•------- BUILDING PERMIT ISSUED---------------------------------- ------------------------------------------- - ----------------_- DATE-----....-. - Alterations and/or recommendations:-__----------------- i-._-__-------------------------------------------------------------------------------------------- ------------------------------•---------•---------.....-------------------•---------•------------------...- ------------------------------------------------------ ----------------------------------------...-----------•-------...------.--••----------•---•-------------------------------- FINAL INS TION BY:.CJ -- ---- - --- ----------- Date__= ( N *,QUIN LOCAL HEALTH DISTRICT 1 0 South Am n Street 3 est Oa Stn it a, 124 Sycamore Street �. �� y 205 Wert 9th Street Stockton,CaliforniaLodi, alif,i is Manteca,California Tracy,California ES 9 REVS 9 2M 5-62 5