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FOR OFFICE USE; ------------------- ------------ ------------i ---------------------------------------------- I-!�--- - UAP[P!LICATIOC m0RrSANITATION PERMIT � Permit No- � J - --------------- -- ----- ------------------------------- ( pee _--•- to Duplicate) -------------------------------- This--- This Permit Expire's 1 Year From Date Issued Date Issued Application is hereby made"to the San Joaquin Local Health District for a permit to construct and install the work herein described. .- Thi. a plication .is made incompliance with County Ordiny ce No. 549. o& t - I--Lo-22, JOB ADDRESS AND LOC T ON. zOe� 1d�'e. rGY/' - 7Po ----------------------------------- Address ----- -------------------------- Owner's Name . .ar -- ------------------ ----------------------------- ------- ---- e Address-----------------• ----- Contractor's Name - Q --------------------------------------------------------------------••---------------- ------ Phone--------------------------••---- N Installation will serve: Resild ence A artment House Commercial ❑ � 4 �p ❑ ❑ Trailer Court ❑ Motel ❑ Other h Number of living units: ___1_ Number of bedrooms Number of bathe �� - / Lot size C --------------------- Wafer Supply: Public syst.1�m ❑ Community system ❑ Private Depth to Water Table•5.O ft. Character of soil to a dept 'of 3 feefc Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made:! (If yes,date..................__) No �New Construction: Yes [�lo ❑ FHA/VA: Yes No t TYPE OF INSTALLATIO AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 11, • Septic Ta Distance f ------------------------------ Size__. 'Y .�h =/ , Liquid depth__. _1 7..._.Capacity_ ------ Disposal F• d: Distance from nearest well______.._Distance from foundat�gn�,___ --------------Distance to nearest lot line,._____... I Numberl of lines---__��_____ ._.___F_"______.__SLength of each line____7��_VJ_ U f�} � _Width of trench_n� "./.--------------------Type of filter material"_1.�� '_Yt�_�1iljepth of filter material �L._"__Tofial length____� Q _____________"--"___ Seepage Pit: Distance to nearest well----------------------Distance from foundation___._ ".______"_.Distance to nearest lot line--____..______._ ❑ Number of pits....;__:___"--________Lining material______--------_-----__Size: Diameter------_---------------- Depth -------------- Cesspool: Distance from nedrest,well------------------Distance from foundation----------._._- Lining material--------------.-_____________________ ❑ Size: Diameter------«---,--- ..------ Depth------------------------- -------------------------- Liquid Capacity-.----------------- --------gals. jPrivy: Distance from�nea e t<well:-"_'__________________________________________Distance from nearest building----------------------------------------- ! ❑ t eaDistance:to rest lot lire------------------------------------------------ Remodeling and/or repairing (dasdribe�:._ --t; ciiCSl C'h�---- `-=---t-•--•-----------------------------------------------•--•----- IIp ___--_____ ------------------------------------ -- - ----------------------------------------------------------------------------------------------------- -------------- ----------------------------------------- =------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1I%ave`prepare d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andel les and regulations of the San Joaquin Local Health District, l� - ------------ -- �-�....�{Signed}------------ -- �" ��=------ �=_--- �- `--�'-�=-� � -- caner- n .{4 a d/o Contras#ter , By------------------- -•° ------ --- -- --�- ��--------------------------------------------------(Title)------D-�� =~J--- ----- -- --------- (Plot plan, showing size of lot,`laca4ion of.system.rin.relafion_fo_wells,,buildings,.efc., canmbe- laced on reverse side). dp P ) FOR DEPARTMENT USE ONLY .;, o APPLICATION ACCEPTEDkBY DATE _y y�---- --------------------------------- REVIEWED BY -'�� ---------------------------------------------------- -- DATE------------ BUILDING PERMIT ISSUED-1111 - ------------------------------------ DA•TE.-- Alterations and/or recomme`rkdations:. f { -----------------------------------------------,I- -- ------------------------- - ----------------------------------------------------------------- ----------------------------------- ------------------- ------------ ---------------- ------- -------•---------------------- I _ 1 FINAL INSPECTION BY:.: _ _ --------- ------ Date-Aa-------?.X_77� SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycdmore_Street 205 West 9th Street i Stdckfan,California Lodi,California Manteca,California Tracy,California . F.IP''.Ca.