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FOR OFFICE USE: -__ APPLICATION- F01�-SANITATION PERMIT 0 Permit No. --- .... ------ -------- --- (Complete•in Duplicate) V IM' _ 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 k ereiyl described. This application r''-made in compliance with County Ord' n e No. 544. �(p wig! . uLKvI..� JOB ADDRESS AND LO TION Owner's Name-------_ - - ------- -- ---------------- Ph nep Address------------------------- iil- - --- .... . Contractor's Name-------------1 �- -- --•- Phone- r/ Q/.._ Installation will serve: Residence A Apart ent House El Commercial ❑ Trailer Court ❑ Motel L] Other ❑ Number of living units: - ----- Number of bedrooms .2-- Number of baths._Z._ Lot size/3A Div:X___ ________________________ __ Water Supply: Publicsystel� Community system E] Private L] Depth to Water Tablet-5 ft Character of soil to a dept" ;of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe'❑.,Hardpan r] r Previous Application Made: i(If yes,date_-.---------....... ) No Z, New Construction: Yes No ❑ FHA/VA: Yes ❑ No)4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or c Isspool permitted if public l sewer is available within 200 feet.)` Septic Tank: „ Distanca�from nearest well—A /."Distance from foundation-/0__ _ Material. .. No. of compartments---0-----------------Size_ __ __+ X , Liquid depth-_. t__...__.Capacity_jZQO , Disposal Field: Distancefrom nearest well_O _ O" istance from foundafion----149........Distance to nearest lot line_-.J`�._._____ Number.;of lines'rkva ______Length of each of trench.._7_4 --------- ----_1 1 Typeof filter materia}_ _ __ _ __ ____Depth of filter mater ial-__. r-__----Total length.... �Q_ E_ _, f8` = Seepage P#: Distance'Jo nearest ell_/VO�1� -Distance om f undation_1 ____.Distance to nearest lot Iine__�j Numpberl�of its_�Z ._ _.--_.._Lining materia!-- -..--- -- Size: Qiawa�er2�C _Ll _Depth ---f 0-----•-•------'------ - 4 Cesspool: Distance..from nearest well ----------------Distance from foundation...._._.-.------- . Lining lmaterial_ __._..__..._______.____..___._______ � Size: Diameter- -- -------------- --- - - - -De th-..___-...._._.____._------- --------------_.---_-Li Liquid Capacity-------------- -------------Sats. I: -"-P L Privy: Distance.°from nearest well.............................._-----------------Distance from nearest building--------_..___-______----__---...;___... ! r ❑ Distancelto nearest lot line..... Remodeling and/or repairinlg (describe): 1. r _ ------------ --------------------------------- -.._. '� ---------- -- - --------"_ Ifi - - - - -- - --------' ----- ------------------ --------------------- ---• ------•-------------------------------------------------------------------------------------------------------- --------------------------------- I hereby certify that I lLv repared this application and that the work will be done in accordance with San Joaquin County - ordinances, State laws, and!!" les and regulations f the San Joaquin "cal Health-District. (Signed)--------------------------- ' r f - . .. -'......... ------------- -•------------------------------.-.-.--(Owner'and/or Contractor) } -----------------------------�l.---- -- - - r-GCMG. itivC.(L -(Title)- By: (Plot plan, showing size of lot, ocat�system in relation o wells, buildings, etc., can be pla!Pon side). � � .� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED IBY a - --------- DATE......---- - REVIEWED-BY -------------------- -------- -- -- ------------------------------------------------------------------- --- DATE--------------------- i BUILDING.PERMIT•ISSUED---•• --------------------------------------- -------------------------------------- ---r--------- Alterations -------Alterations and/or recommendations:----------- ----- - -- ........ -------------.-----------------------`---7------------------------- ---------•------------ -----------= i�- -- -- -- ----------------------------------------- i5; --.....'" - -�2.�-ems. - �Rr- ----- - -•----- --- ------------------------ 0 ----= --- �.1 I �------- --- ---------------------------- _ I� i - r l II �} i FINAL INSPECTION BY!.! .� o - ----------- -.1:7_-11----------- Date------ -C4_J---. - SAN JOAQUIN LOCAL HEALTH DISTRICT t 1401 E.Hazelton Ave. ' 300 West Oak Street 124 Sycamore Street-.w —*— 205 West 9th Street r t Lodi, California s Manteca,California, Tracy,California " Stockton,California E.H.9 2M 1-67 Vanguard Press f _ a �