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FOR OFFICE USE: _ APPLICATION`FOS SANITATION PERMIT Permit No. �_ _ _ - ...�°�.�..._�.G ------ ---- ----------------- ------ --- --- ----------- (Complete in Duplicate) / Date issued --_----�-_--�-� -..-----_.........................................._._ 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. 1 JOB ADDRESS AND LOCATION-------- -400-7------------!� - -------Z�Z5�---------- -------------------------- --------------------------- Owner's Name-------------- -0 11V ------®��3- -�----------------------------_ ----------------------------------------- Phone------------------------------ Address--------------------------------J.!Z _-�-9--c-&-�--------------------•--------•--•--------------------------......----•------------------•--------- Contractor's Name-------------C--- ----------- {------ ----------------------- Phone---------------------------------- Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---t... Number of bedrooms 71= Number of baths ----I... Lot size ____ Z_A__..X_ -j fi Water Supply: Public system ❑ Community system ❑ Private (; Depth to Water Table _�O_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ Previous Application Made: (If yes,dote....... .............) No X New Construction: Yes ❑ No [[. FHA/VA: Yes ❑ No o TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----67a----Distance from foundation---__Z�{______Materipl-------- ---------- --._____-__. r [A 6LJ4 No. of compartments-----.fir------------Size___3_ -- -_!c__ __,___Liquid depth-------/ Capacity___ __. Disposal Field: Distance from nearest well------ -r...Distance from foundation------1_0.1-------Distance to nearest lot line------A---4_._ f J Number of lines------------!...--- Length of each line------------�0------------Width of trench._.___.- -29L �� G()' Type of filter material_____�k- Depth of filter material----.---(_k__.____.Total length_______.__'____-.__•---_-_ Seepage Pit: Distance to nearest well Dp----__.___Distance from foundation___x47_....___.Distance to nearest lot line___- 51 CAVI Number of pits---.----d-------------Lining material-S;_fiece,k-Size: Diameter---------4&.. Depth------------ -------- Q i Cesspool: D'stance from nearest-well-----_-----------Distance from foundation--------------------Lining material____________------_.-_-____.-_-_-__._ ❑ Size: Diameter------------------------------------ Depth----------- -------------------- - - ---------------Liquid Capacity----------------------------gals. - - Privy: Distance from nearest well-----------------------4�_-_---___-___.____Di0ance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------- ------- ----------------------------- ---------------- ----------- ------------------------------------------------------------- Remodeling and/or repairingdescribe):--------- ----------�------- -..- . sem-'----:--- +a� ------ `-------------------- -----------------=-- `f S11--------------------------- 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. } -------------------------------------------Owner and/or Contractor)y ----------- (Signed)------------- - By:------ -----------ZL0---- ------------- -- -----t----- --------------------------------------------- -----(Title)--------------------- (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY - k- 7_ APPLICATION ACCEPTED BY___._ _� ems" DATE 5700-__4;4 REVIEWEDBY------------------ ---------- -------------------------------- ------ -------------------------------------------------- DATE----------------- ------------------------------------------ kBUILDING PERMIT ISSUED 1 ---------••-I---------------------=--------------- DATE---------------------------------------------- -------------- Alterations and/or recommendations:-----'----------- -- --------------------------------------- -----------------------`--•-••-------------------------------------------------------- 41_1571�'a-------- ---------5C3-,j00------------ -------------------- - _.-_--------- -------- ------------ .. F. FINAL INSPECTION BY:------ . -------------- ----- --- ----- ----- Date-------Q- ------- - ---- ------ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C{]. / F - F