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FOR OFFICE USE: ' J r .j4;7_l - -Z-----------------�----�---- Permit No. .cz� 3 •� APPLICATION POR SANITATION PERMIT -------------- ---- ---- ------------------ ---------- ------------- (Complete in Duplicate) Data Issued Zcr 2__:&-"4�� I This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND LOCATION(---- /2 ° . - - ----- } f If - �-- Owner's Name i ------Xj,� /J _ r--;---------------------------=------------------ ' Phone-- fir a � Address----- � S'7- `n ---------------------•---------------- 'j Contractor's Name -----------------------® P -..-..----••--------�------------------------------------------------- Phone.. !I Installation will serve: Residence A artment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __. -_'N Number of bedrooms -- _ Number of baths _.---- Lot size ------------------------------------------------------------ # Water Supply: Public systemlidI!Community system El Private []r Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay (2 Adobe ❑ Hardpan ❑ A, Previous Application Made: (If yes,datei-'-----------------) No [31N Construction: Yes ❑ No F] FHA/VA: Yes ❑ No ® I TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No Septic tank or cesspool permitted if public sewer is available within 200 feez.t P nearest well----d ; Distance from foundation---- �? `� CapacityQ -(s Se Septic Tank: Notaof com artments-i------Z----.--... Size----- -x.�---X--�°----3_J!Cl�id depth --` . -..... Disposal Field: Distance from;nearest well---��_.-._Distance from foundation_-.-b�-----_- Distance t- nearest lot line---- Number of lin�s._-.-____o'?_ - -----.-----Length of each line----�-0� O: _ _._Wiclth of .trench....... `f------------------- 9 ' Type of filter material_---- a_C_1_(---Depth of filter material-----�_6_-.-------Total length____--/0-------------- ------- _ _ , Seepage Pit: Distance to nearest --- -.---- ---------Distance from foundation-------------------.Distance to nearest lot line___--_--------_.- ❑ Number of pA _Lining material---------------------..Size: Diameter-----------------------Dept'r,-__-___-.-.--------------------- lCesspool: Distance frcm� nearest well-----------------Distance from foundation----------------_._.Lining material ---...----------- -_--- ❑ Size: Diameter--------------------------------------Depth-------------------------------•-----. -------------Liquid Capacity----------------------------gals. I - Privy: Distance from nearest well--------------------------------------------- -.-Distance from nearest building-------------- ---------- ------- ❑ Distance to nearest lot line------ ---------------- -- -- --------- --------------------------------------------- -------------------------------- ----------------------------------------- -------------- - -------------------- Remodeling and/or repairing (describe):-------AZe_u ----_------------------ � _' ------- r ! Ip = _ ---------------------------------------------------------------------•- -------- ; - __ i 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) 13y: f�tt L 2 —`�`-'--------------- -----------------------------------------------------(Title) f r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). !I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- . --- --------------- - DATE 1Z - !� REVIEWEDBY-------- ----------- ------------------ -------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED--- �� ---------------------------------- DATE--------------- ----------------------------------------- / --- f� � � �- y --- --- ------ - Alterations and/or recommendati � �� (�""� _- � _- _ --r----_--- ---- - ---------- - --------- -- ---- -- ---- lGi'3--A.... ----- ------------- - ----------------------- --- - ---------- - ------------ ---- -------------- A10 !111 FINAL INSPECTION BY Gv,� ..: Date--------- : � � -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Aro. I 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cu.