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Permit No. -- - °Z -- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued l ehl 5-�--- J " 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 Orr&nnaance No. 549. ,. v !/W -- ----- JOB ADDRESS AND LOCATION---------------J-----------------------_------- Owner's Name I !' ` ------------------------------------- - ------------- _ -------------- Phone_ -f`l ti F ,• Address..------ _ Contractor's Name -' ✓ ---- Phone Installation will serve: Residence &--gpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _./-- Number of bedrooms _'�Z Number of baths -%#__ Lot size _ -X__1,4!--------------------------- Water Supply: Public system'yr_Commuriity system ❑ Private ❑ Depth to Water Table -�_ ft.l Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made.- Yes I] No R�lew Construction: Yes ❑ No V?` FHA/VA: Yes 94-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ----------:------Distance from foundation--------------------Material---------------------------•-------------........ ance from A�l Nlotof compartme ts+-w II Size --------------------------------Liquid Liquiddepth----------------- --------Capacity-•--------------------- pos field: Distance from nearest well-!---------------Distance from found _ ation____ ____---______.Distance to nearest lot line ----------------- _� Number of lines--------------- -------------------Length of each line-------------------------------Width of trench----------------------------------- ! Type of filter material-_____:------------------Depth of filter material----___ -_T fol length----------..---------•----------4f------- 20 .. t Seepage Pit: Distance to nearest ell -�istance,f om fou ation__ istaXn�ce to nearest lot Ian _____________� Number of pits------p ------------Lining material _�e�5ize: Diameter_��___-_ Depth, = Cesspool: Distance from nearest well__.-----------.Distance from foundation--------------------Lining material__________________._____------______. ❑ Size: Diameter------------------------------- ----Depth----------------------------------- ----------------Liquid Capacity__-----------------------gals. Privy: Distance from nearest well-----,--------------------------------------------Distance from nearest building--------------------------------.--------\{ ❑ Distance to nearest lot line------------------------- --------- --- ----------------------------------------- ------------------------- v 2 Remodeling and/or repairing (describe):---------A ' -----•------------------------•-•-------- V_4_ --- 1- -".---------------"-------------------------------------•--------------------------"-"---------•------------------------------"-"-----•--------------------------•------------------•---•------------------•------"-----.-.--- L 1 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 r les and regulat'ons of the San Joaquin Local Health District, x ----------- (Signed) 4lwoo or Contractor) ------------------- ------- - ---------------_----- r {Title) ---- - - ---- (Plot plan, showing size of lot, to ion of system in relation to wells, buildings, etc., can be-placed on reverse si e). FOR DEPARTMENT USE ONLY _ I APPLICATION ACCEPTED BY - -"� = ` DATE j tf�--�--- --------- ' - -- DATE REVIEWEDBY--------------------- ---------------- ------- --- BUILDINGPERMIT ISSUED----------------------------- (------------ --------------------------------:--- DATE Alterations and/or recommendations:------------------------- ----�*-------------------- ------------------------------ ---••---=--------•------------------------ ------------------- 119=17---S7---------1✓�t ? iT._.�?s....-------Q 0-0-�'�-----P1-2"-- ... ------------------- --------------------------------------------- ---------------------------------------- ------------- ---------------------------------------------------------------------------------------- --------------------------------------------------------------- -----------------`------'------------ -------- k FINAL INSPECTION BY:------ --------------------- Date------- � � ----- -SAN JOAQUIN CAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockt nCalifornia Lodi, California Manteca, California Tracy, California �5-9-21x1 , Revised 1-57 F.P.CO.