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rum UrF-1C.t USE: ......... .......... ..... •• ••............... APPLICATION FORSANITATION PERMIT Permit No, /.r_...1 """-.-"' "-' {Complete in Duplicate} This Permit Ex ires 1 Year From Date Issuod ' • ' Date Issued �..' .r,'.•._,� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a plication,is made, in.. compliance with County Ordinance No. 549; ft-f-16,4-WA 1 1917- 090rs( JOB ADDRESS AND OCATigN.:--, ��` 1c.. ??c` ..... Owner's Nar - 4�.... ...... ......... r...... . ..................... Address........ t.br.. �'�7.. one....................................^.. Contractor's Name....._..... ............................ Vv ... ............................... _......... Phone ...........:...... •� ' Installation will serve: Residence p ""--"""'•'•- ❑ A artment House (] Commercial [+'Trailer Court ❑ Motel ❑ Other ❑ � l Number of living units:..."-. Number of bedrooms - ----- Number of baths '' Lot size ___" '-' _ 49—A..,, Water Supply; Public system ❑ Community system ............. ............ Y Y ❑ Private E J60 th to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ iSandy Loam 4"'Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: llf yes, dote --1 No ❑ New Construction; Yes ❑ No ❑ FHA/VA: Yes ❑ No [] TYPE OF INSTALLATION AND SPECIFICATIONS: t {No eptfc -tank or cesspool permitted if public sewer is available within 200 feet.) nk: Septic TaDistance 'from .nearest well................. Distance from Foundation.....•-.-..., , M I, '- R ... areria. ❑ No. of compartments........ ............................. r Size................................ Liquid depth............. ........... Capacity. ........ sposa Field: Distance from nearest weU:.-4xA --;Distance,from foundation...... .......Distance to nearestar lot line...-?..�.,--, Number of lines.. er'i' ........................ Length of each line. �A..'._... Width of trench... . 1 >.. _ .- I Type of filter material... •>�� ""'"""' "sn"'...... "'Depth bf filter material_......l.f f.-...... Total length .......f Q.�.:........ . ..... Seepage it: Distance to nearest well .�'��,�-.-%` •,_Distance from foundation.::../..p.:.....'Dis#once to nearest lot fine.... s. �.. Number of its .1... ' ......... Linin material... ..S.:. ?......_ '' Cesspool: p ,r g .r . ?.. Size: fDiarneter j.�.;33.;...... Depth.......',.......... �. ❑p Distance from nearest well..._. ._.... :Di3tance from found fion ..................•Lining material............... Size: Diameter............. i Depth................ •....................... . Liquid Capacity.......... ..............gals. Privy: Distance from nearest woll ........................ .�..D;stance from nearest k�aiding. ............- Distance, to nearest tot line ............. ......r£..... ................................... Remodeling orid/or repairing (describe):... ' r1: 4: 1 r- ...................... ........... z ............ I hereby certify that I have propared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andregulations of the San Joaquin Local Health District. (Signed) ............... By:........... . ............!^..... and/or Contractor) ............. ... ......... ...................... ..... (Title).......... . Mot plan, showing size of lot, location of syst m in rel tion to wells, buildings, etc., can be placed on reverse side). DEPARTMENT USE ONLY --- — — I -- --- APPLICATION ACC FPTF.D BY... _ -z« t y�-r_!i', .. ................... .......... . .... ........ . ...... DATE .... _.� .- REVIEWED BY.. .......... ............... ................_ .. .................................... DATE...-......_........... BUILDING PERMIT ISSUED ................. .... Alterations and/or recommendations: .................. .............. ......... ............. `......------- .--- .................................... ti. ................ ................... I1............... ................ .. ...... ............... ................... ................ ........ FINAL INSPECTION-BY:. ........ Date........ -CZ ........................ . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Haiallon Avv. t 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon, California Lodi, California Manteca, California i. Tracy, California