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FOR OFFICE USE: i '------ Permit Na. _,1. _. ..� 0 ---- - _"" "" APPLICATION FOR SANITATION PERM (Complete in Duplicate) Date 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 herein described. This application is made in compliance with County Ordinance No. 549. �—•P,J: D a5--13 D -c� JOB ADDRESS AND LOCATION__ Owner s Name---------??�.},/-----�/�'-�. - ----••--- - i------ --------------------------------------------- Address-_ --.•--.... ------ Contractor's Name-----• -------"------------------------------• --•-- Installation will serve: Residence ;fl Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ iv�k,iii.ici �� S�V��ty w�i��-.1.-=----�-- 11,ln.obr=rF 6o�tonmS___-_ _-_ Number of baths __�:.- Lot size ._�_A.-5't --• ---1-- -- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a�depth of'3rfeet: `�SanJ L-i .,raveF' ��arlu�! zOW'. u r�u,l �'ry rZ- ria"-r7_ A�lnl�a MHardpan I l Previous Application Made: (if yes,date--"-_"-"-.-_.-.---I No IN New Construction: Yes IN No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ]! .. • Material---�il''t nt'�."-.._...._."............. Septic Tank: Distance from nearest well-�0 __pis#a❑c� frQm foundation_--..�..__ Ca aci « •--•• N No. of compartments-----j�- Size -CJx' 7 Liquid depth-..:" ------- P ty. 1 Disposal Field: Distance from nearest well-, �--"-."Distance from foundation._ ._._--...__.Distance to nearest lot line.*_--------- Number of lines---•--'��- -•-- ----- ---------Length of.each line---:_ ----4 Width of trench.-! --------- \I i R -- Type of filter materla�_ Depth of'filtsr materia!____._ Total length-. -..!R-.---••---------•-- tG Seepage Pit: Distance to nearest well----/-O"®-_-----_Distance from oundation_.A� -----------Distance to nearest lot line".udf_;__-------- Number of its"_ Lining material _- Size: Diameter -----------Depth-- p ----- -- Cess Cesspool: Distance from nearest well-- .----__--.._Distance from foundation_---"--___-.------Lining material_.--.--_-"-------•---------------- L p Depth-----------------------------------"----------------Liquid Capacity..---"-------------------_9 ❑ Size: Diameter----------------- ----------=----- - `- --------------------"----Distance from nearest building Distance from nearest well---�---------------- g---------------------------------•------- Privy: ------ r ❑ -----------•----------Distance to nearest lot ine"-_"_"---------------------------- ------- -----"" -------- 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. (Sign ----------------------------"--------- - -"" "-".- -----{Owner and/or Contractor) - ------ -- ---- _. -- By:- -----•-••---------•---- ------ ---------------------------------------------------- (Plot ----- --- --------------- ----- {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_- - -- - ------E ------------_--- -------------------- ------------------- DATE-.��`fl_��--�------------------------------ -----------. DATE-------------------------------------------------------- BUILDING BY---------------------------------------------------- --------- ------------------•--------- -- ---------••-- DATE-------•--------- rBUILDING PERMIT ISSUED..---------------------------------------------------------------•-------------------- Alterations and/or recommendations:------------------------- -----•-------------- --------------------------------------- ------------ _45 ----"---•----------•----•--------•--- � -----•- -- •--- - - - �` Ctt�,-- - -- - � '"" ----•- l ' -' �,Ino_t '` ,. -------------------------------- -------- ---------------------- ----- ------- ` Date- 6 --------------- -----•--------- FINAL INSPECTION ------------------- SAN ----------- •-----SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street 130 South American Street Trac California Stecklon,California Lodi,California Manteca,California y� ES 9 REVISED 8.59 2M 5.62 ATLAS , m