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p 1-UK UI-F,-LE USE: ----------------- -------- ---- --------- ---------------- APPLICATION FOR!_-SANITATION PERMIT Permit No. .c��S^�� . 4 ------- ------:-------------------------- ---------- (Complete-in Duplicate) --- ------ -------------- This Permit Ex ires 1 Year From Date Issued Date issued Application is herebymade to the San Joaquin Local Health District for a permit to construct and ins+all the work herein described. This application is made in compliance'With County Ordinance No. 549. JOB ADDRESS AND LO TION___ Owner's Name---•-----_--- - P one. Address.---•-•----------•-------=- _ Contractor's Name------.____ ------ - - -------- -- ------ ------ -e— ----------------- Phone. Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court/ Motel ❑ Other ❑ Number of living units:-Number of bedrooms _49 Number of baths Lot sixze -___y__ yy. Pell--- J JXS------------------ Water Supply: Public system [ Community system ❑ Private X Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy.Loam [] Clay Loam E] Clay ❑ Adobe 6�" Hardpan ❑ Previous Application Made: (if yes date.......__-------- ) No, New Construction: Yes ' No El 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__.1:!r_0----Distance:from foundation--/G -------..Material No, of com artments_. - _. Size2C7 -E �-�---Liquid ------- "I -. apacity- V2jC? Disposal Field: Distance from nearest we --__-Distance from foundation__��__r___...Distance to nearest lot Number of lines ______ -- Length of each line__ ---��...------fir. --.Width of french---- Type SY" Type of filter material__ - -- Depth of filter material__-. Q------_-.-Total len th___ length---Pit: Distance to nearest well_. -_r-.-Distance fro foundation_/Q.---_-----Distance to nearest lot line__._ j Number of pits_-_ _ -- ~ __.._Lining material_--l .- Size: Diameter__ rr Depth - -�-r'`-- Cesspool: Distance from nearest well ----------------Distance from foundation- ----- . Lining material--- -- ------- E ---------------- ❑ Sze: Diameter- -- ------ --- --- - ---- ---Depth------ -- --------------------- ------- -- --- ...Liquid CapacitY- ---------------------------gals. -------- ---------- -----gals. Distance.to nearest lot line - Privy: Distance from nearest well___ __ _ .___-------____________....Distance from nearest buildin __ ___ --------------------- - ------ ---------- Remodeling and/or repairing (describe):....--------------- --------_ -------------------------- ------------- -----...- ,. ------------------------- --- ---------- - - ----- ----- - --- ---- - - - - - l:hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. . [Signed) Ct _..._. � 3 r_*—�•- ---------------- - ---- ---- -__. Owne and/or Contractor) BY�-----------L--.�---•e----- - - --- - - - --- -)Title}--4z .... � (Plot plan, showing size of l ocation of stem in relation to wells, buil mgs, etc., can be placed on rev se side). I FOR DEPARTMENT USE ON Y� APPLICATION ACCEPTED B ---- DATE------ -------------- c 'H�7 _:__ A PLIC .. - --------- ----------- - �--- --- - - BIJILDi ED BY- - - REVIEW ------- ---------- ------ DATE-------------- --------------------------------------- - ------------ NG PERMIT ISSUED-----•-- -- -- - ------- ----- -- -------------------------- - ------------------------------ DATE.- --,----------------------------- ------- ------------- Alterations and/or recommendations___________ - -- - ------------------- --------- ----------- ----- - - ---- -/-.z'.. ---------4: �' - --- -- { - ---------- ----- ------- --------------------- ------------------- ----- -- -------- FINAL INSPECTION BY:.:X 4eV�M Q 2g &$ - # Date- / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 Wast 9th Street `Stockton,California Lodi. California Manteca,California E.H.92M 1.67 Vanguard Press Tracy,California i