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X` FOR OFFICE_USE: f ' -.. � -3 ---- ----- Permit No. �_j -Z_Z 42, / .----------- 1.3o APPLICATION FORSANITATION PERMIT .• (Complete-in Duplicate) Date Issued - -------------------- ----------- --------- This Permit Expires 1 Year F..ram-Date Issued K 1 All Application is hereby made to the-San Joaq in-Local_Health..Distri6tjdr a:p re mit to construct and install the work herein described. This application is made in compliance with County Ordinance No.'54� � CC C: , '�. / ------------ ------ t JOB ADDRESS AND LOCATION_.--7.��- �------�-�---------- - - -------------------------------------- - Owner's Name / G' - 5 - ------- ------ -------- ------------------ Phone Address -- -- -------- r ------�K/`--'-- ` --------------------------- ------------------- •----•----------------------- ' 3 �b a Contractor's Name----{ --------------�- J-6-R-��KJ Phone T..-.lQ Installation will se e1:*.Residen e,% Apartment House ❑ Commercial ❑ Trdiler Court ❑ Motel ❑ Other ❑ o Number of liven units:g j i Number of bedrooms -_�-- Number of baths.-_ Lot size ----. --- -------- -------- -------------_-.--.------..--_- . Water Supply. Public system EI) Community system [:1Private;❑ Depth to Water Table ------ - ft Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [IClay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,dote................... ) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` i ( septic tank cesspool lP lwt public sewer� ca20eet.) Septic Tan Distance from nearest el - 5.0is#anefrom founda0 - Material ------ ------ p-f.--e.---------. No.'of compartments.------,�-------__.-Size------------ ---- ------Liquid depth--------- ---Capacity--4 U Disposal Field: Distance from nearest well---�0/---Distance from foundation----/-Cl........_Distance to nearest lol)ine----- -------- Number"of lines----/---------------_.__ Length-,.of each line-- --IQQ._/- f.------.Width of trench._--�_-----_-._0- I, . �_ a. Type'of filter material�QC� .-Depth—of filter-material-_1f...-..- length-.-..--./ -----.Total - Seepage Pit:.21Cf.7}�j,tance to nearest well----1,406--------Distance�om fou dation----�D---------.Distance to nearest lqt i• -- -- / - _ �j if Number of pits... --�---..._.____Lining material-- -._. . ..-- Size:'Diameter '...................Depth�.�_ -�-- -. 1 Cesspool: Distance from nearest well __----______--.Distance fro foundation.................._Lining material--------------------------------- Liquid ❑ . ` Sze': Diameter- -- ----------- ----- ----------be -- -------- - -- -------------_..Liquid Capacity gals. Privy: Distance front} nearest well.,------------------ -----------------------------Distance from nearest building ❑ Distance to nearest lot fine-----------------i------------ -- --------------------------------------------------- ---------------------- ---------- ------------------ • Remodeling and/or repairing (describe)---------------............ ---------- -- ---- - =----- ---------------- ------------ ..................................... - --- - ----------------------------- = ------------------------------ I hereby certify that I haveipre:pared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules'a' regulations of the San Joaquin Local Health District. f (Sig ------ . -Gi" - - - ---- - - -------------------------------------- (Owner and/or Contractor) _------ ! ( plan, showing --------------------------------------------------------- ------------------- ------(Title)------ ---- ---- ------ ........--...- I. Plot lan, showing size of lot,ilocation of system in relation to wells, buildings,.etc., can.be placed on reverse side}. FO EPARTMENT USE ONLY w . APPLICATION ACCEPTED BY-- .- . - -- -- --- --------------------------- ------------ DATE------3_-7,_X;? 7 ---- ------------------ 'F REVIEWED BY-------------------------------- ----- ------------------ ------ DATE------------ --------------------------------------------------------------------- ----------------- -------- --------------------------- BUILDING PERMIT ISSUED---------- ---------- --------------------------- ----------------------- --- ------ ------- DATE---.- - Altera ions and/or recommendation`-„ '-�3 `� ---------�? � ------ ------•-•-------- FINAL INSPECTION BY:.... ------------------ --------- Date--- - ` ` `� 7 -- --- --- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press