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FOR OFFICE USE: ---------------- Do 3 -------_-.--_ �.---.------- APPLICATIOU,7E,.0R..SANITATION P NEi rmit No. ........................ AN ------ -- ------------------------------------------- - {Complete in Duplicate} `µ >- te Issued-t'�_r.:jL�'__.� --------------------------------- This Permit Expires 1 Year From Date Issue 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. - 4 JOB ADDRESS AND LOCATION....... ...... ( -------------- -----------.� � Owner's Name--------- GtJ`Z/I�—`—'tan-�'c -- Phone------------------------------------ =•---------------- - Address ..�� c C�------2�-- --- .�-------------C-- ---- � -------------------------------------------- •-----------•------------ s. ContractorsName-----------------------•--------------�-------•---.L.------- '.��.p ---L—I-�=�-'�--�----------- --� �'�------------ ---------- hone--------------------------------- • Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Otherf � } - - - r Number of living units: J Number of bedrooms _ ,Number-of baths '. Lot size ---. ._Cr[� ..- -�'� �______________ Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table ft. Character�ofsoil to a depth of 3 fee+: Sand ❑ Gravel E] Sandy Loam E] Clay Loam lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {if yes,date---------------- No [ New Construction: Yes R"'No ❑ FHA/VA: Yes ❑ No ❑ ! TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--S0_--Distance from foundation-----l e_-----.Material-f� --------------------------------- No of . compartments- ---------vJ Size- t t Capacity-_ -�- F-. - quep .......- Disposaeld: Distance from nearestlwell .....D+stance-from foundation-- --(�-pDistance to nearest lot ine-----�f }--/--" -. Number:of lines------3--__ ---.--.______Length of each -.Width of french.____-� _l---- ________________ Type ` of filer material_!,_jf&--��Depfh of filter material....... .-Tota l length. _104_1— Seepage Pit: Distance�to nearest well.___�_Cr ?Distance from foundation-_-l.v_�_-_--Distanco�o nearest lot line--------- 6 Number of pits-------Z..........Lining mate ria l__4S /(:5'k"__``&e Diameter._ -3 p �_ Cesspool: Distance from nearest well--------- -------Distance from foundation.;..___..__._.__.Lining material_-.. material. ....-____------------------- ---- ❑ Size: Diameter ------ Dept ---- ------------- -----Li Liquid Capacity ------------.gals. s Privy: Distance from nearest wel------------------------- ---------------------Distance from;nearest building___.,.________________---__ 9 ❑ I Distanceto nearest lot line--------------------------------------------------------------------- -------- ----•-------------------------------------------------------- 6� Remodeling and/or repairing (describe]:...` -. - ��Z__• ._ -_ _____ r .� •- --•--•---------------------------------------------------------------------------- ------------ ------------------------------------------------------------------------------------------------------------------------------ F i � ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State1aw nd p4les and regulations of the San Joaquin Local Health District. 4 i (Signed) --- ----- - - -- -- ------- (Owner and/or Contractor) ..-.Title (Plot'plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- . - ry -----------------•----------------------- DATE.......`� cam , REVIEWEDBY------------------------------------- ----------5------------------------------------------------ -------- ---------------- DATE-------- -----------•--•------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------- -- - -- ------------- DATE------------------------------------------------------------- Alterations and/or recomniendations: `3 �� ----------[-- g_e —�r ' - ---------- - t � 'f -- -------------- -c'- -------------- -----a- �' f cs — -�_ — ---------- -- ---------------------------------------------- ----------- ----------------------------------------------------------------------------------------------------------------------------------------------- ---------------- ------------------- ----------------------------- .................. --------- ------------------------------- ---•------------------------------------- ---- -------------------------------- FINAL INSPECTION BY: Date_..-- `a-` :. �_ SAN JOAQUIN LOCAL HEALTH DISTRICT., 1601 E.Hat:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 n. :