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FOR OFFICE USE: ----------- -------------------------------------------- APPLICATIONS SANITATION PERMIT Permit No. .. f- ------------ --------------- (Complete in Duplicate) ------------ - ---- This Permit Ex fres '1 Year From Date Issued Date Issued`.- _ 3- ----- 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. S49. JOB ADDRESS AND LOCATION-----------CLOKW. -----�----- 1------ ----'-------------------•------------------------------------------------ Owner's Name--------•-----•AlZT4 11R------MACHADD-....------•------------------_--------- - --------------" ---... Phone--RSS--�n�i�0 Address222 1.. U 2 • l ---.-•---------•-------------------------------------------------------- Contractor's Name----------------------------------®(V!Q L.------------------------------------------------------------------------------------- Phone---- F--------------- Installation will serve: Residence [Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms --3--'Number of baths -------- Lot size ---- ---------------------------------------- Water Supply: Public system ❑ Community system ❑ Private 2"Depth to Water Table --6._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------- -----------) No ®— New Construction: Yes ❑ No F 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—AD--------Distance from foundation------ - ----------M LeaL---__ � _-----_-----------. 9T,- No. of compartments..........oQ------------Size------------------ ------------Liquid depth--------q�---------Capacity---1'dix-1.------ Disposal Field: Distance from nearest welL--'.S-Q.......Distance from foundation-__-- c°>}-t?-------.Distance to nearest lot line--r�--------- Q' Number of lines--------------5-------------------Length of each line----------i --�..- ----..Width of trench.-- --- -----.----------:.----- Type of fi#ter material--_-o�p�'_ k.__Depth of__filter material---_-��----------Total length-----------Qi6--------------------- Seepage Pit: Distance to nearest well-----___-----------.._Distance from foundation---------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter------.---.--.-.-.----.Dept h----.-.--.-.------------------.-- Cesspool: D;stance from nearest well.---_- -_-Distance from foundation ...... .......Lining rriaterial-------------------------------------- El -. ---------_---- -_- - - ❑ Size: Diameter------ ------------------- ---Depth------ ---- --------------- Liquid Capacity- -----gals Privy: Distance from nearest well ------------------------------------------Distance from nearest building------------------------------ ❑ Distance to nearest lot line-------- -- ------ ------------------------------------------------- ------------------------------------------------- -------------------- Remodeling and/or repairing (describe) -------------------------------------------•------ ------------------------- --_----- •=--•---------------- ---------------------------- -------------------------------------------------------------------- •:-------------------------------•-------------------------------------------------------------------- ---- ------ I 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)------- ------------ ------- ---------- -------- --------------------------------- - ---------------------------------------------------(Owner and/or Contractor) T - -----(Title)---- . - .....................(Plot plan, showing s!'e' of lot, 'cation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY • APPLICATION ACCEPTED 13Y----- ------- - ..... -------------------. -_----- ----------------------=--- DATE----- i - l.. ✓-------------------------- - -_ - . . - = REVIEWEDBY----------------------------- -------- ---- -------------------- ------------------------------------------------------- DATE----------------------------------------------•---- BUILDINGPERMIT ISSUED----- --- -------------------------------------------------------------------------------------- DATE----:-----------------------------•- ---------------------- Alterations and/or recommendations:----TANK_....-k .......>_--_ L !2k-------- p.--_ ?---------. - -----------------•---•-------------------------------•------------------------•-------- ............... ----------------- ------------------•--------------- ......•----------------------------- --------------------------------------------------------------•----------------.---------------------------=------------------------------- ------ - --------- ------ -------------------------------------------- ---------------- --------------------- ------ --------------------=-------------------------------------------------------- ----------- 4 - � _ FINAL fNSPECTION BY:. Date-------- I--Pti .2 S OAIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ` Manteca,California Tracy,California CS 9 REVISED 6-59 3M 3-'63 F.F.CC.