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FOR OFFICE USE: = L--75:;;1/----------------P- Permit No. � ..., ----------- .11011-ff_ APPLICATION FOR SANITATION PERMIT ------ ------------- - (Complete in Duplicate} pate 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 herei described.This application is made in compliance with County Ordinance No..549. +OA) -- 1070^-t00~QT . � JOB DDRESS AND LOCATION./x0---,e---� ---el�l�_l iv s ------------ - Phone------------------------------------ ---------------------------------------------------------------------------------- Name----- c.�__.�/�j----��.-.--:�lr.�'r��.�_'__1��---------- - ------ - ----- ------------: ---- AddressEl 's ----------------------•-------------------------------•--- Contractor's Name---------- --------------------•--------------•----•--- Phone--__---- . --------- Installation will serve: Residence g]"A'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--_ Number of bedrooms J_:_ Number of baths ___ Lot size/40?7X--1-40------- --------------- Water SuPPI • Publics stem ❑ CommunitY system �r•vate. ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No Z4-""New Construction: Yes U; 1�o [ FHA/VA: Yes Z�—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .� �`----------------------- 1 �� Material Tank: .- Distance from nearest well_________________Distance from foundation___ ____- ____... _ �" No. of compartments---�----------------Size*' _ �rquid depth------"1C�__...--------Capacity �, i Disposal Field: Distance from neares well--_'"'�----_Distance from foundation__/"._ __--__Distance to nearest I!t line_ " ___.--_. Number of lines____ f---- ------ --,Length of each line-_ j. Width of trench_12----�-------------------L � Type of filter material.XX - epth of filter material,�4__--'__-Total length,/ � _____-------------------- Seepage Pit: Distance to neares well_- Distance fr m fo dation-_%O_..-___..Dista ce to nearest lot line_ ''- --.- ' Number of pits...p ------------Lining material- elz Size: Diametei.3;. Deptn--.._ 'v Cesspoa Distance from nearest well___-___._____._-Distance from foundation---------------_---_Lining material--------------------------------- I _-.__....__-_______________- - .___. ❑ Size: Diameter------------------------------- -----Death------------------�--------------- -------- --------Liquid Capacity--------------------- gals. Privy: Distance from nearest well-----------------------------------------------_Distance from nearest building_._._----.-____----______-_-____----___.-. ❑ Distance to nearest lot line-------- - ---- ------- - -------Z---------------------------------------------------------- -------------------------------------------- Remodeling and/or repairing (describe):- -----------------------------------------•----------- -'- ---------------------------- ------------ m ------------ �•L' --------------------------------------------------------------------------------------- k----------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 41 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. A /or Contractor (Signed} - I a i - --- r--------(Tit ey- � ..------ ------- - -- N. (Plot plan, showing size of lot, location of system in re! n o wells, buildings, etc., can be placed on reverse side}. FO DEPARTMENT USE ONLY . i "` ---------------- DATE----n= -LN--- --- - --------------------------- APPLICATION ACCEPTED BY- ---��}MA---- - --- ------- ---- ------ ----------------- - REVIEWEDBY--------------------------------4=------- -------------------------- ------------------------------------------------ DATE----- -----------------------------•----------------------- BUILDING PERMIT ISSUED--------------------- ---------------------------- ------------------------ --- ---- ►DATE -------- - - Alterations and/or,recommendations:--- -----•-----•---------------------•-----------•-•-•------------ 3 ----- - ---- - - :_-----o1,Y1 rIn-�a- 46-------- -- 1111 ---?lln-----�. -A � - - r-- �s FINAL INSPECTION BY:_ Y: _ - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 4 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California .Lodi,California Manteca,California Tracy,California