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OROFFICE SE: r. i APPLICATION FOR SANITATION PERMIT Permit No. ----- ------- -- ------- ------ ------- ----------------- (Complete in Duplicate) /- This Permit Expires 1 Year From Date Issued Date Issued .cr. _._.._ 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........... p -t4- /------- GX C --- �-- /a % Owner's Name �/9 -- ------------- Z/77 -V5{ Address__- 45 !�e-----7C�--- / 11 S TG�fCTG/f/ ------•--------------•---------------------------------- ------•--- -----------•-- ------•------------------------------------ Contractor's Name-----------6P-W41AW ----------------------------------------------- Phone-.------------------------------- Installation will serve: Residenceg] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms .4---- Number of baths ..f.-. Lot size ---/`S-4 C'.� `�-------------------------- Water Supply: Public system El Community system El Private ® Depth to Water Table 6-7-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 19 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------.-------) No-0 New Construction: Yes M No ❑ FHA/VA: Yes ❑ Non TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewdr is available within 200 feet.) Septic Tank: Distance from nearest well.-��....-.Distance from foundation Mterial..✓ -. u/UU 91 No. of compa menu----------..2..-------size- �x. f�-7/.--:._.Liquid depth_-1-�--------.-_--Capacity-.FaG Disposal Field: Distance from nearest well-SQ_.__---Distance from foundation_. ._-._..-.Distance to nearest lot line_—�^...._.... Number of lines.------.._.-UNe----------Length of each line---------e.0-_.-------_.Width of trench-- -24 C> / i� 1--------------------- Type of filter material?.q MC<Depfh of filter material-- -._� ..-Total length---.....�.�-_------------------_-. Seepage Pit: Distance to nearest wed l-------------_-.,__,Distance from foundation------------------- Distance to nearest lot line_.._-__.-___ ❑ Number of pits----------------------Lining material----------------------Size: Diameter.-------------.--------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material_-------------- -_.--------. ❑ Size: Diameter--------------------------------•- ---Depth=------- :;----------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from' nearest well'___ .._------ ------------------------Distance from nearest building----------------------------__-.-------- ❑. _ ., , Distance to nearest lot line- ------------------------------------------ ----------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)------------------ ------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ---- - 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 regulations of the San Joaquin Local Health District. (Signed)------- --------- ----- 4-. (Owner and r onr on rac� ---- --- - - - -- --- -- --- ------------------ ------------ By:------ � ' ------- - (Title) (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 APPLICATION ACCEPTED BY f --------------------- DATE----------- s��. .-- REVIEWEDBY--------------------------------- ---------- -------------------------------------------------------------------------------- DATE------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------ F F. Alterations and/or recommendations:--__.-.- --- -- - - --4-- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ------------- ----------- ------ --------- ------ ------------------------------------------------------ ------------------------------------------------- 11 I� -----7 !� Date-----_C.�A�-�-� ------- -------------- -- FINAL INSPECTION BY: 1'� 67 -------- SAN JOA IN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California F.FZ0.