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FOR OFFICE USE: / 7 -------- --- . Permit No. --------------------------------------------------------- ------------- --------------- - APPLICATION 'TFOR °SANITATION PERMIT ------------------------- �-1 ----------------------- --- __ --- --___----_ (Complete in Duplicate) Date Issued _____---_-- •- ---� 3 This Permit Expires 1 Year From Date Issue :2 5 0_11,0_ 07 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. �- i ------ `- - - JOB ADDRESS AND LOCATION_____ - -------- � r � Phone----••------------ Owner's Name--------------- -e ' ' tom-`F�- ----- --I 1P ----------------------- ��,..� T--------------------------- Phone----------------------------------- ----Name--------- - ---- - ------ ----------- -- -•-- --- -------- ---- A artmen Hou ❑ Commercial ❑ Trailer Court 0 Motel � Other ❑ Installation will serve: Res'den� ❑- �pi f ! R. Number of living units: __.____ Number of be rooms __.:`z_. Number of baths __�_ Lot size ._____-_[____ __________________________________.._____-_ Communit s stem ❑ Private � Depth to Water Table __�_/"ft• Water Supply: Public system ❑ Y Y Adobe 4 Hardpan ❑ Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑FHA/VA: Yes No �- — Previous Application Made: llfyes,date.................. .) No Pk New Construction: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: W No septic tank or cesspool permitted if public sewer is available within 200 feet.) V1 Septic Tank: Distance from nearest well--- from foundation----- b � �C _ No. of compartments j' Size l�_X_5�...Liquid depth------- � Capacity---- -_ - Dis sal Field: Distance from nearest well_.-- p.-.-Distance froJ cf k_u1e ation:--T-�d-----. --Distanceifttrenche5}_ {-k ----- - (m' Length of ch `"Sia 70 `-'� z {�1 Number of line __5 g << Type of filter material_��2.-� --Depth of filter material_______l_ --- -----To length ' earest lot line________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to n .--____:_ Lining material-----------------------Size: Diameter----------------- ----Depth------ -------------------------- ❑ Number of pits-------------------- mater Cesspool: Distance from nearest well-----------------Distance from foundation------------------- ning Ca aial gals. w.. EJSize: Diameter----------------------------- --------Depth--------------------- ---------------------------- Liquidp Y-------------------------- Privy: Distance from nearest well------------------------------ --- ------- -- Distance from -nearest building.•----------------------------------------- ❑ Distance to nearest lot 2 li7ne------------� ------------ ----�-------------------------------------------------------------' ------ and/or repairing � rlbe)dt i._r_._3 .......... ---------------------_---------------»----------------_------------------------------------------------------------------------------------------------------------.---------- 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 regulatt4, ,, the San Joaquin Local Health District. t� f1 `------------------------ ____________________Owner and/or Contractor) (Signed)-- � Z�- -----•- --------------------------------- --- - (Title)--------------------------- ------- --- --------- -.-.. By:--------------------- . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------ ---------------------- ------------------------------------------------------------- DATE------------------------------------------------------------ REVIEWED BY----- --------------------------------------------------------------- DATE_ o%r 1 � ; DATE BUILDING PERMIT ISSUED------- ------------------------ ---------- --- ---- -------- -- - ----------------------------------------------------- Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ----------------------------- ------------------------- -- Date-- ---------- ---- ----------------------- ------------------- FINAL INSPECTION BY------------- ------------------------------------------------- 7 jai------------�7---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3oo West Oak Street 124 Sycamore Street 205 west 9th Street Lodi,California Manteca,California Tracy,California Stockton,California w ES 9 REVISED B-59 3M 3-'63 F.P.DD.