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.EOR(OFFICE USE: " 11 = -- / APPLICATION FOR- SANITATION PERMIT Permit No. ....f.� -- (Complete in Duplicate) 1 / lJ �.- Expiresr . Date Issued ---� � G f 6' ' This Permit 1 Year From 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 LOCATION ------------ =- . 1'-- Q-- f�/ '� ` Owner's Name_- -�.--- /?�(L�_�/ /-------- ----- Phone ---- ------------------------------ y Address----_---------------- fir'------ ---------------I——-- Contractor's Name--- -- -----•------------------ •--- Phone Installation will serve:. Residence P—Apartment House ❑ Commercial Trailer Court - ❑ ❑ MotelEL Other ❑ Number of living units: Number of bedrooms , Number of baths ..../_ Lot size -------17 C-12 y ❑� Community system 0 Water Supply: Public system y y ❑ Private Depth to Water Table�,,S�t. Character of soil to a depth of 3 feet: Sand ❑ Gravel,[] Sand Loam ❑ Clay'Loam ❑ Clay ❑ Adobe < ardpan ❑ 1 � Previous Application Made: (If yes,date_____________ --1 No New Construction: Yes ❑ No ]/FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND.SPECIFICATIONS: (No septic tank or cesspool permitted.�if pubiic'sewer is available within 200 feet.) Septic T : Distance from nearest well-----------------Distance from foundation-----_---- -_-----Material- ---__.--_--___-_..--_--.-.--_---- `� �' e Disposal r efd:' iostance from st well_. 4_-�.-.-DZe Liquid depth----------------- --------Capacity----------------------- p stance from foundational_ -_---.Distance to nearest lot line_,,1 f Number of iri�esi _--_ ! _---Length of each line-__ -_ --�r - €dth of trench---�_1;e / -- _ Type of filter material-__ _ - -( .11Depth of filter material--- _ - !L__-.-._Total length-.. Seepage Distance to nearest well---c i7-___Distance m foundation---1Q__�_-_Distance to nearest lot line�.y------- Number of pits: � '---Lining material_-:.G-�Size:'Diamefer.- �� � l .�..�a ----- ----. Cesspool: $`ry ance`from foundation..:................ .Lining material-------------------------------------- El _.---_-------___---- . ess❑oo : Size: Diameter---fl rest well Dl r th` # =" Liquid Capacity gals. Privy: Distance fromrnearesf weft._.��-------------------------------------_Distance from nearest building r g---- - Distance to nearest lot line_._.__- A ,� -- ------ --- - Remodel in ci gand/or repairin ------ - _ - - A - -- --------- f i __---------------------------------- --{"__------------------_-_-- I hereby'certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and L46i4npl regulatio o e San oaquin Local Health District. / v (Signed) --------------- ---- ;' ---- - - - ------ -------- ---------------------------------- (Owner ar actor)I Y ------------------ --- �� =`. {Ti+le) (Plot plan, showing size of lot, location of system in-relation to wells, btdings, etc., can be placed on reverse side). P � e FOR DEPARTMENT USE ONLY APPLICATION /CCE PTSD BY-_ -••- •------ ----- l ------------ ----------------- ------------- DATE-----_.�-- ---- -,-,------ �-�-- - ,----- -- --='-'_--- REVIEWED BY �` i -. - ._._--------- -------------------------------------- DATE-------------------- - BUILDING PERMIT ISSUED------------------------=------- - DATE----------_--- Al+erations. and/or,recommend tions:_',__ ------------- 1 ; --------------'--- --------------f5------------- - �_ ✓•�+�- "�A � -� �-----�'--------- ------- �-E`er----•-�-�----�--�---------f ------- -----------�-- -- - -----• ----- ------------ ----------------- ------------- -- - -- -------------------------- -------------------•------------- ------------------- -------------------- . - _ FINAL INSPECTION BY:---- _. • ---- Date---- AN ate--- �f - - / AN JOAQUIN LOCAL HEALTH DISTRICT A ; t �! 1601 E.Haallon Ave, 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California of Manteca,Calif6rniu Tracy,California a,y.s+�•.d 111. 'n6 t E!�� ! � xf, j�. .} � � "F