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k; FO OFFICE USE: - 1318- " -- - - Permit No. I U ---------- --------- ---- ---- S '- ------ ------- APPLICATION FOR SANITATION PERMIT - ------- --------- ------------------'- (Complete iDuplicate)ete n upcate) _ . Date Issued ---- --------------- ___---_--._ --- This Permit Expires 1 Year From DateAssued r Application is hereby made to the San Joaquin Loca€ Healfih Disfirict fora permi}to construct and install the work herein described. Th07 is application is made in compliance with County Ordinance No. 549. C�7fJ- O`70� �5"� ^�' ; �I c✓rt`s2,4 f J /.__ 11f4lf JOB ADDRESS AND L ATION_ .�-_" /0/` 0 �1 i Phone_ --•----------------------- Owner's Name- ------- - - - i« 4 ' Address-----i--------------•--------------- : 'dT---------•I ------------------ --------------- ---------__-- C G� ; ------------- ------ Phone..---------------- -Contractors Name Installation will serve: Residence Lp-'�pertment House ❑ Commercial ❑ Trailer Court ❑ tel Other ❑ Z, Lot size ------ `,7JC�I- "°,.----------------- Number of living units: _-�___ Number of bedrooms _�._ Number of baths_ '----- Water Supply: Public system ❑' Community system ❑i Private i�Depth to Water Table.,,, ft. Character of soil to a depth'of 3 feet: iSand E] Gravel El Sandy Loam El Clay Loam [I Clay E3 Adobe ardpan ❑ Previous Application Made: .{if yes,date_________________ J No New Construction: Yes No ❑ FHA/VA: Yes [4-"50.El OF INSTALLATION AND SPECIPICATIONS: r f (No septic tank or cesspool permitted if.public_sewer�is available within_200 feet.) Septic T k: Distance from nearest-well-1-51-D-____ Distance fiorrs foundation�C-_____.___..Material---- z�"C--�C'�----------- No, of com artmen#s____ _...."_Size"_ -- y� quid r epth_..__��/-------------"-Capacity../_�L,,*0.--- i Disposal Field: Distance from nearest well--- __�._Distance from_foundation -- � __.Distance to nearest lot line_ /__.. /i y _..____---Length of each line" ��' -�'�-�-.Width of trench_._r/_: ----------------- Numberr o4 lines t=Type of.filter material �?[__� Depth of filter material_�x- ______.Total Iengfh__c�?__.y__1--- 1 _1 . e Seepage Pit: Distance to nearest well______________________Distance from foundation_______-.-_________.D�stance to nearest lot line------- ❑ Number of pits --------Lining material � �' Size -------------------- Diameter �----------.Depth Cesspool: Distance from nearest well_________________Distance from foundation..------._.-_____.Lining material-------------------.----------------- ❑ Size: Diameter ------------------------------Depth------------- ------------------ -- --------------Liquid Capacity----------------------------9als. Q Privy: Distance from nearest well., `..._ ______I----------------------------Distance from nearest building--------------.--------------------- _- ( ---------- ----------------------------------i-------------------------------- ❑ Distance to nearest lot line---------Remodeling and/or repairing (describe):..:'_--'. . / �� ;� ----------•------------------- ------------------ ---.--- --------." ------�---____-_# -----------------------'----__"_____-____"__-.___ -------------------- ' ------------------------------------------------------------ -------------------- 1 hereby certifjo , repared this applica+ion and that thee work will be-done in accordance with San Joaquin County ordinances, State land r ations of the San Joaquin Local Health District. ' '----------(Owner and/or Contractor) - - (Signed) ---------- -- -- --- --------------------:--•.------------------can bele)la (Plot plan, showingtionto system in relation to wells, buildings, etc., c placed on reverse side). FOR DEPARTMENT USE ONLY 4 .�; APPLICATION ACCEPTED BY_.%-�------ - --- ---------------------------------------- DATE---- a 1 �°-- --'------------------- REVIEWEDBY----------------------------------------- •- --- DATE---'-.---------- ------------------------------------------ BUILDINGPERMIT ISSU.ED------------------------ -------------' ----- -- - ------------------------------------ DATE----- ------------------------------------------------------ Alterations and/or recommbndations:----------------- ----- -----------------•----------•------ -------•------------------------------------•-- ------------------ ----- -------------------------------------------- " ' ' FINAL INSPECTION BY:..... ._%_---- �-------- Z � Date. b SAN JOAQUIN LOCAL HEALTH DISTRICT % /.t 1401 E.Haielton Ave. 300 West Oak Street j 124 Sycamore"Street 205 West 91h Street Stockton,California Lodi,California 3 Manteca,California Tracy,California F.P.CC.