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FOR OFFICE USE: — � ------------------_-.____-__-____--------------------._ APPLICATION FOR SANITATION PERMIT Permit No.6�2,1.'2�.Z-_-_ ----------------------------------------------- ------ (Complete in Duplicate) -1v_67 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 work herein described. This application is made in compliance with County Ordinance No. 549. n A JOS ADDRESS AND LOCATIO ---Wi--- - _-Q�~ --- � I,� ----- __. "t.T -----•0-1 --"s, ' Owner's Name--- L-8--ER-7--Aw—D------ANs�-G,g-lo------3- `--R.8-SS-Q------..-.. Phone------------------------------- Address-----------------I\7_...... 4 U©? 0.�(4� y ®G`P�- �. .__..'--! / L ` �/ Contractor's Name .. ---, i 1 ------------•------ ---------•------ Phone 4�Flt 04f r Installation will serve: Residence 91 Apartment House ❑n'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.._ Number of bedrooms _'[ Number of baths ..�___. Lot size _- --- ----- - --- -------- Number of living units: --I---- Number of bedrooms Number of baths J---- Lot size -'i 1:114�------------------------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table 7S7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe Hardpan 01�k Previous Application Made: (If yes,date--------------------I No PL New Construction: Yes ❑ No K FHA/VA: Yes ❑ No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ ___-Dis#ante from foundation.�Q-r------..Materia4..... _... _. . --- ---- ----e -------- No. No. of compartments .......... - �,I p ---17, depth----..�� -- Capactty__a_O�Disposal Field: Qistance from nearest well- _______Distance from foundation..f _____._ _�istance to nearest lot line.. Number of lines--_7w ------Length of each 49-Width of trench.. ." ------------------ Type -- ----------Type of filter material._ ---Depth of filter material--- .......Total length.... .._- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest loft 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 --------------------------------------------------------------------------------------------------- -- - ------- --- Remodeling and/or repairing (describe):---- --- ---- - - --------- - - -- -- -- - ----------- --------_------------ -- _...-- _-- -------------------------------------•------------------------ ------------•--•------------------ ------------- - ----- -------------- -- -- -- ------------------ - ------------ - ------------- --------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have repared this application and that the ark will be done in accordance with San Joaquin County ordinances, State I , n rules d regulatic of the San Joaquin cal Health District. (Signed)-------------- ----------------- --- off -$-�------ ------- E ----.(Owner and/or Contractor) f BY: G%�r� l ( (Ti+le) - - -- -+------------------------------ (Plot plan, showing size of lot, location of system in relatio to wells, buildings, e+c., can be placedldn reverse side). FOR DEPARTMENT USE ONLY l I APPLICATION ACCEPTED BY------------- ------ ----------------------------------------------------------------------- DATE----------410Af7---------------------------- � REVIEWED BY--------------------- ------------------------ DATE-------- -- ------------------------------------------------ ' BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------- ------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------------------- ------------------------------------------------------------------------------------------------ ------------------- -- ------------------ ---------- --•---------------------=---------------------------------------- ------••---•-------•--------•---------------------------------------------- -------------------------- -------- ----------------------------------------------- -------------------------•---------------------------------.---------------------------------------------------- ------------------- / - FINAL INSPECTION BY:........ '------------411-��,------ Date----------- / --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.14asellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California 1