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APPLICATION FOR SANITATION PERMIT Permit No. i (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued Application is hereby made to the.San Joaquin Local Health District for Date issued __- This application is made in compliaiince with County Ordinance No. +544 a permit to construct and install the work herein described, JOB ADDRESS AND LOCATION{-- Owner's Name__. /✓ �� . Gt ooc _ -------------- ----- -- -------- Contractor's ------ Address-------------------- --- - ----- --- -------��4-I91i4 - _•-----------------•----------- ------------------------------- ------- ------____..-----•-••---...__.__-.---•--•-- Contractor's Name___--____---- ori Co �z � �-- Phone..__._. Installation will serve: Residence - Apartment House ❑ Commercial Number of living units: ❑ Trailgr Court ❑ Motel ❑ Other ❑ '� -- Number of bedrooms -�. -_ Number of baths �_�7-Lot size __-- Water Supply: Public system ❑ Number system ------------ Y ❑ Private,, Depth to Water Table Ap Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ] Adobe j Previous Application Made: Yes E] No � New Construction: Yes No ❑ ardpari ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ FHA/VA: Yes ❑ No-K, (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) "`� P m n, crest well_- :'�� Distance from foundation_ � - .------.Materiai-----eo4,C 0/6 1 Septic an No+of tomance o artments___--_ __ Size_____ ---------Liquid dep'th--------------------------Field: Distance from nearest well.-. pf Capacity--f4?__!� Distance from foundation_______ ___ ______Distance to nearest lot line------- Type ___.__.._____.__ Number of lines--------------__3 . _-Length of each line_-_-___- -------- - T e of filter material-----_ /QDe M of filter material---_--_/ .�f_ _olalthle gt nth--- ______ __.__._ Yp _* �'yr P _ ! �_. `. Seepage Pit: ---� umber f nearest well______________________Distance from foundation_________________.-.Distance to nearest lot line -_-__--_-__---- ❑ Number o{ pits___________________Lining material----------------------- } Size: Diameter----------------------- Cess ool: -� .Depth- -------------------- p Distance from nearest well-----------------Distance from foundation____________________Lining material--___.------------------------------ i -_---_-_-_ wY~ ❑ Size: Diameter--------------------------------------- Depth-------- ------ ----- - -----..................... ---------- Privy: Distance from nearest well Liquid Capacity___________________ gals. t F ________--Distance•from nearest building---------------- ❑ Distance to nearest lot line --- -- ; -------- -- - -- - -- -- -- ---------------- ----- --- ---- -- -- Remodeling and/or repairing (describe)::___-__ i -- ---------------------------- ----- '--------------------------------------------------- ----- tti f t - -- -- -- ------ ---- - --------------------- ---------------------------------------------- ----------------------- I 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 and 'regulations of the San Joaquin Local Health District. (Signed)--- --- & r r ----------------- ----- --�-F- � ' V � ¢ $ ------5 .(Owner and/or Contra r) (rile)------- -------------------------- (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). � jr FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_--- ! f�1 . - ------- ---------------------------------------- DATE REVIEWED BY_..` ------------------------ �~ 40-------- BUILDING PERMIT ISSUED r ' DATE ------------------------------- ------------------ --------------------------- DATEAlterations and/or recommendations:_ _, ----------------------•----------------------- ----------------- - - - - -- ---- ---- - ------- 2-- _ --- FINALI - ------------ - Date--- - ----- ------------- ------------------------------------ OAQUIN LOCAL HEALTH DISTRICT G� / SAN Jy� 3: 130 South American Street ^-� 300 West Oak Street 132 S �k,. / — Sycamore Street 814 North „C„ Lodi, California M5tree+ Manteca, California Tracy, California ES-9-2M Revised$-'59 F-P.co.