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PR OFFICE USE: ------------- ----- = 0.. Permit No. 1 2 ---- ---------- --------------- --------- 441 APPLICATION FOR ,SANITATION PERMIT in Duplicate) -- --�---- ---------- -------= (Complete.: p� ) Date Issued ----- -�-��,? This Permit Expires 1 Year From Date Issue n_,�� , p�� _ 1 � OS --------------------------- ----------- . Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal!the work herein described. This application is made in compliance with County Ordinance No. 549. 1 t1= w GST OF JOS ADDRESS AND LOCATION._13.PX`�".1-a--•----- _�. � �J_Lk__1 ,.------ ---- Owner's Name-----D�..i��--`-5-------i='��2-Y'_�_�_Ir'- ----------- --------- - ---.-. Phone._93J_.7--P_R?1<. - Contractor's Name------ _Y-�1_�i=�_S S--�-�--�---�--- .�._y 1110—91`--•----------•----- ------ -----•.__.. Phone.A.64__-_4A41--- Installation will serve: Residence Apartment House [jCommercial ElTrailer Court ❑ Motel ElOther C1t Number of living units: __l___- Number of bedrooms _3___ Number of baths 2-_ __ Lot size ----- 4CZ& --------------------- � Water Supply: Public system ❑ Community system ❑ Private ;< Depth to Water Table _4Q ft. Character of soil to a depth of 3 feet: Sand F1Gravel ❑ Sandy Loam [I Clay Loam El Clay ❑ Adobe)6 Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No V New Construction: Yes No ❑ 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___�S_O......Distance from foundation--._l_D -------.Materl____�°P__IV.C' -T ------------- y. No.-of compartments---------y----------Size---Sf ICaS X--1-_O --Liquid depth------_V 1----------Capacity-11-00---.9#4 #4 Disposal Field: Distance from nearest well. -.Distance from foundation-----LD ......Distance to nearest lot line___---.�r f Number of lines------------%.__ -----------Length of each line----------7S-------------Width of trench-------------- ------------ Type of filter material._,$._. � Depth of filter material____.._-le ----Total length___________________�s O_----- Seepage Pit: Distance to nearest well---100---._-----Distance from, foundation----- to nearest lot line��-------- Y .. Number of pits--------/�---------Lining mat erial_S.- C7�Size: -Diameter---.--- --------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation}_._1.'--------_.Lining material---_____________________.__.__--____. ❑ Size: Diameter------------------ -------------------Depth---------------------------------------4"---- Liquid Capacity gals. i� est building------ Privy: Distance from nearest well---------------------------- ---------- Distance from near ----- ❑ Distance to nearest lot line----------------------------------------------------- ----------------- ------------------- ---------- Remodeling and/or repairing (describe):------ ---.---- LcJ-------,r-3,"s-M—-------- ----------------------------------- �- ----------------------------------------------- ------------------------------ :..1.3 is 44 , ---------- -- ------- -------•----------- _, =•----------------•----------------------------------------;-----.;---------------- ,juin - n -- � j I hereby certify that I raa a prepared this application and that the work will be done in accordancee with San Joaquin County ordinances, State laws, andirules and regulations of the San Joaquin Local Health District. . r q ----------------------------------------------- (Owner and/or Contractor] (Signed) ---- r t -'`-- ------ ---------------------- Title g ,Q�, ^ - -- ----------- { } (p (Plot plan, showing size of I' cation of system in relation tci wells, buildings, etc., can be placed on reverse side]. F R'DEQART.MENT USE-ONLY Ma l 5 APPLICATION ACCEPTED BY---------- z ---=- ---------------------- DATE. --- ---- -- - - ----------- --- REVIEWEDBY----------------- - ------------------------ - ----------- -----=------------------- -------------------------------------- DATE- ---- BUILDING PERMIT ISSUED-------------- �' DATE /�� - - I Alterations and/or recommendations:__-__--._..__ -�=- ` . --------- 01 � - - - - - - .�._--.--.------ --- -- ._. yF- ------------------- ----------------------------------- -- -------- Date_ .------ -------------------------- -- -- -------- -- -- ------ ------ -- ON Y'-',:------ - �FINAL INSPECTI SAN JOA IN LOCAL HEALTH DISTRICT 1601 E.ma:elton Ave. 3oo West Oak Street 124 Sycamore Street 205 West 9th Street t Stockton,California Lodi,California Y Manteca,California Tracy,California F.P.CO.