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FOR OFFICE.USE: -------- M Permit No. - 1 & APPLICATION FOR SANITATION =PERMIT ------p �4+-4,t o 0 - (Complete in Duplicate) Date issued ------------------------------------------ _ This Permit Ex fires 1 Year FroDate Issued ruct and install the work herein describe d. Application is hereby made to the San Joaquin Local Health District for a permit to const This application is made in compliance with County Ordinance No. 549. ----------- -------•------------------------- JOB ADDRESS ANDALTION_____ - _ _ Owner's Name ---------------------------- 71 _ I ----------------- C ---- �----- : Phone n Address_ d�-G� € ,. ne-------- --------------- ---- ------------- Contractor's Name------------ --•----- G` �r--------------=-- 4 Pho + Commercial Trai(er�-Court ❑ Motel ❑ other ❑ Installation w111 serve.: Residencepartment Hou ❑ l x ---------------------- oo of living units:.;_._1<_- Number of bedrooms __"A Number of ba#hs _____!___ Lot size ______ __-.__ Community ❑ Depth to Water.Tab9e._____._ ft. Water Supply:-,Public sys#em 3❑ it temY ss [] -Private v{ ,� Clay Adobelardpan ❑ 4' '` Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Y ❑ Character of soli to a depth of13 feet: Sand'fl:n / PKANA; Yes ❑ No r ►/New Construction: Yes.®/1�0 ❑ Previous Application Made: (if yes,date___----------- 1 No [ „ TYPE OF INSTALLATION AND SPECIFICATIONS: ',, ` (No septic tank or cesspool permitted'if--Public sewer-is available within 200 fe}.)�.` 3 s �1 Ta Y Ca acif"` • Distance from nearest we4l_` ._�lG__`Distance�fram found tion____�K" ______-Matarlal_____. __ -Septic Size :-' f Liquid depj h = a'. p Y+ �/ No. of compartments_-___.-__ -! -- �� -^ .- .- -�� " Distance to nearest lot Ie_____"_± •__-- Disposal d: Distance from nearest,well_, /1'e--Distance from founds+ion__-__-•_ Number of lines________:1------ =""IJ. Length of each line----------""'-----�� Widfih of trench_._.__---f Total length-------16-Q--------------------- Type of filter materiakS� C.ls4 I Depth of filter material___��_-------- , 0 Seepage Pit: Distance to nearest well__.__-�Ly�n----�Distance from foundation�iarrieter Distance to Depth lot !ire_--__--_------- O ❑ Number of}pits__ ._ -_ - 9 ,•�' Ij i 1 Distance from neares#-well,_g :_-- --._-Distance from'foundation_-`_ _�' �• .Lining' material 'v l Cesspool: "~ �;a_:u1.-_Li Liquid Capacity # --------gals. Size: Diameter # ----------- ---------Depth-_' " -----:- q p Y ❑ _._Distance from nearest building ------------------------------------ i Distance from nearest well-________________________________________ ; Privy: -- 4 ❑ Distance to neares+ lot fine------------------------- -------------- rlm ` ` 6 _"--__ -- I p f Remo eling and/or repairin escribe)::) --- - __ _________________ C t - --- - - I---- - ----------- S w� - - --- ------------ ------------------ -------------------------------------------------------------------------------------------------- ----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules a d regulations of the San Joaquin Local. Health District. �•. ----- --------------------------------- (Signed) - (Owner and/or Contractor} -- ------ - - Title t By=------------------------------------------------------ - (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).1. '" FOR DEPARTMENT USE ONLY i f APPLICATION ACCEPTED BY-`l__--- ---- ----•------------------- -------------------------------- DATE----- ! �� -.�r. ._----------------------------- I -- t —f` �: DATE-------------------------------------- REVIEWED BY. - -------------------------------- i ------------- DATE-------------------------------------- BUILDING PERMIT ISSUED -- . Alteratio Vsa d/orr c mm dations:_______._-.__ -- - - �-io s ` ' '- � -- --------------- ----- ---------- __ = c( —7c Y - ------------------------- - --'`� �. -- ., Q --�-,-,,�- - -------------- ------------------ ------------- - - ------- ---------- -. — z �/- ho c �� -c ' `K� Five , �� p 2�Lru - 6ArA /_ Date.. /— -- ------------------------------- FI'NAL INSPECTION B :.------- - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasollon Ago. 300 West Oak Street 124 Sycomore Street 205 West 91h Street Lodi,California Manteca,California Tracy,California Stockton,California ES 9 ItEVIsro 8-59 3M 3-'63