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FOR OFFICE USE: :. -=-. -. --- -APPLICATION.-FaR SANITATION•'PERMIT Permit No. s - .. -------------- -------------------------- ------ ------ E (Complete in Duplicate) / ---------------------------------------- This Permit Expires 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--_---C;,2/- _ --------Col-__ _ -_. _ t _ Owner's Name------/J' t------ ---•---• ----- - __ Phone��6_--------------------------- Address 9^- 0/ V6 ---- - --------- ----- - ------------ ---------- ----------- - -------- Address-----•----.rte =-------------------------- r / �. r ld Contractor's Name-----`----- ------- -------------•----- 42? - ------ Phone. __.. :,114 i Installation will serve: Residence [-Apartment House ❑ : Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-::Number of bedrooms _v2._ Number of baths __/_ Lot size --- I_.X 13sr 0 a Water Supply:* Public system 211'Community system ❑ Private.❑ Depth to Water Table �ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe RKardpan ❑ Previous Application Made: (If yes,date--------------------) No D *'-New Construction: Yes ❑ No E4--"FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r x p�ic nk: Distance from nearest well_______________Distance from foundation�._______________Material............................-___----------------- No. of compartments--------------- -----Size-'---------F------ ------------Liquid-depth---------- ---:----------Capacity----------------------- f � e Disposal Meld: Distance from nearest well_ k4. __. istance from foundation--__45----_.Distance to nearest lot line___5_____.___._ ...... n r _ ,. Number of Imes-__.�_-__-__-__ Length of each line____-3D_ ----------------Width of trench...__ _$!_______._�___.____ d Type of filter material_S<__ _QC_ _.__De Depth of filter material-__/e--_-___._Total len'th---------------------s. _d--_._.___-.-- yp -' p g t}1 Seepage Pit: Distance to nearest we11:;Eo.&10---Distance om foundation___./4.....__...Distance to nearest lot line--__:5....... [+� Number of pits----- ---------------Linin material_ Qc Size: Diameter----,;� _47. _ Depth------107 ---4r Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material------------------------------------- El Size: Diameter--------- -------- --------- - -------Depth------------------------------------ --------------Liquid Capacity----------------------------gals: Privy: Distance from nearest well-------------.-----------------------------------Distance from nearest building.-.-----_____._________________________. ❑ Distance to nearest lotline--------------------------------------- ----------------=------------------------ ------ ----------- ------------------- Remodeling and/or repairing (describe)------------------------------------- ---------•------------------------------------------•-------------------------------------------- --------- ------------------------'--- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------ = =------------------------------------------------------------------------------------------------------------------------------------------ I hereby .certify'that I have prepared this applice�ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re lotions of the San Joaquin Local Health District. 00. 1 o(Signed) �lr------ --- - --------------- --4_0 �--� ,- 1 r ---(Owner and/or Contractor) BY:---- --------- --------- -----------------------------------��-��---- --------------r - - - -----------------{Title) (Plot plan, showing size of lot, location of system in relation to wells uildings, etc., can be placed on reverse side). i 46 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------l ___---. ---.- .--- = DATE . . REVIEWED BY ----- ----- --------------------------------------------------- DATE------- BUILDING PERMIT ISSUED----------------------------------------------------------------- ---- -------------- DATE---------------------------------------------------------- Alterations -- --------------------- Alterations and/ci recommendations:---- -3_ 4---__�... �:-------��'` -•--- ----- �`= 't A -a_.S'r-.------- ------------- ---.__ -, �� ;-----� ' -- ------- -- --------------------•--------------------------------------------------------------------•- ---------------------------------------------------------------- ------- ------------------------ -------------------------------------------------------------------------------------------•--------------------- --------------------------- -------------------------------•--•-------- - --•- -- --- ----------------------- ------- ----------------•-------•--------------------------------------------------------------------------- FINAL INSPECTION BY: `= -- ---- �C' ---- ------------- Date..... ................ ....... ---------------------------- N J A IN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California r•.P.ao.