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I}f FOR OFFICE USE:� l {/ ---------------------------- Per-- ' ------------------ ..---- -_`_--------- -- -_--- APPLICATION POR SANITATION PERMIT mit No. _ --,._. W. -..-v --------------- - -- �� (Complete in+Duplicate) _________.r,_____1r_._._ This Permit Expires 1 Year From Date Issued Date Issued ... Application is hereby mad.1 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. :. f �I�. 13l JOB ADDRESS LOCA EON.,-•-- Gr' 0 - ---------------------------------------------------------------------- Owner s Name--- --- - J-- a Phone Address---- .1�, ._--•-. . -- - t R - _..._-..»... -----------------------------_._.__ - Conf uor's Name-----`------ ' ------------ ------ -- --------------- -------------------- Phone-------=-----------------'--------- -------------- Installation will serve: r Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .Ir:. f Number of living units:.__!____•"N umber,of,.bedrooms _�,Num_ber_ of baths-__f._-•Lot size --- x �b_______________________ ---------- Water Supply-' Public system E]mmunity system ❑ Private Depth to Water Table Fl//_p- ft. ` Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ -Adobe tj-_Hardpan ❑` F 111 Previous Application Made: (If yes,date __________________] No New Construction: Yes o E] FHA/VA: Yes E] No S __ r s ti TYPE OF INSTALLATION AND SPECIFICATIONS: f, -'w - '�► i (No septic tank`,or cesspool permitted if public sewer is available wilfhin 200 feet.) i Septic T k:, Distant from nearest well__,_.!_._=Distance from f'pCundation___/0____ Material________ ___________________ _____ __________ I ! P i! N'. of compartments-------------------Size..--3Xx 5 Liqu:d depth - Capacity.. �!a? -``�� Disposal Field Distance from nearest well__.--- ----._Distance from foundation--------------------Distance to nearest lot line------- [ Number; of lines----------------------- II -Length of each line_ @_------------_----.Wid+h oftrench.-2 _ --_---- ] Type of,filter. material_= �i: S --Depfhrof_filter-material/A'-4_=- --___-_Total. length__:_ �_�----------------------------- j Seepage Pit: Distance I ❑ 'i �� to nearest well_.,------ ---------- Distanc�om foundation-------_6i, .t. .___.Distance to nearest 4lot line_, .?-__-___-__--.__-- :IINumber of pits---- _--------- - Lining m4ateriaLA�P.C-A _-_.Size: Diameter---------�-3_.---___Depth----7ZA7�/---- -------- sack from ndarest well____________3._ Distanee from founclation_- __ 'i-_-__Lining maferi ----------------- Cesspool. D --------- Size: _.___Size: Diameter---------------------------- ------ Dept -------------------- ---=--------------- -------Liquid Capacity_ .........................gals . Distance from nearest well_________________ - Distance from nearest building--i Privy: �;! q, ._.....,�-�--=�-�=--------------- g--'-------------------------------------- 1: ----------------------..---- -- - ❑ --------------------------------------------------------- Remodeling --------------° l.; Distance to nearest lot Ime------------------------- - - =` -- ----------------=� Remodeling and/or repairing (describe __________--------------------------------I---- --------------------------------------------- -------------------------------------------------------------------------------------------------------F -I I I -lh------•- -- --------------------------------------------------------`--- --------------------- --------------------------- ------------- --------------------._------ kllir.hereby'certify that I!lhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an8 rules and reqjation of the San Joaquin Local Health District. ;. (Signed) ------------- pca . (O. ner and/or Cantractor ) Titler- = ..._ . : ------------ t )------r---- --------------.. --------- {Plot plan. showing size of II ocafion�of.,system,in-relation}o-wells,,buildings,-.etc.,can--b'e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- 0-01-5e;1 - "e�� - ------------------------------------------------------------ DATE---- � ------ --- --------- REVIEWED BY----- A .............................................. -------------. -- s ----------- BUILDING PERMIT ISSUED ------------- --------------------------==--g_------------------------------------ - = SATE - ---------------------- Al+erations and/or recompiendations:___ _.._-.___ � - - _-__- ' ° ------------------ 1(63 ----------- ---------------------- - 1 - � .. --" ----- - ... ..... --- �- --------`------��- -------- --------------- ------------------- --------------- ------ "r - FINAL INSPECTION BY: Date __/ _ -- -- - ` - �r� SAN JOAQUIN LOCAL HEALTH DISTRICT MOVE.Haxelton Ave;. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t�o Lodi,California Manteca,California Trac California Stockton,California y, INS 9 REV16EO19-59 3M 3-•63;F.P.0O. ' I