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FOR OFFICE USE: - -- - � PERMIT - Permit No. ."22.�_-. u ION - --- ----------// v __ __- APPLICATION FOR SANITATION ---------- ---------------------- ------------------- (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. r JOB ADDRESS AND LOCATION--------- -:ZS------ �71-------, '1c ------------------------------ "------------ Owner's Name----------l ----------- —---- Phone------------------------•--------•--- Address----------------- - ----- �------�---•- ------- ------ ---� -- ...._� - ..--------------------------------------------------------Phone "---- • - ------- ----�-� - ------ _ �J Contractor's Name "` 7 Installation will serve: Residence [—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j----- Number of bedrooms -z--.-- Number of baths J----- Lot size ----- L� -- Water Supply: Public system e— Community system ❑ Private ❑ Depth to Water Table 9f- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe-[ ' Hardpan ❑ Previous Application Made: Ilf yes,date--------------------) No [!} New Construction: Yes ❑ No [�J- FHA/VA: Yes ❑ No Ej-- 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_---------------Distance from foundation--------------------Material -------____-------.--..-------------._.___-----. s� No. of compartmems-------------------- -----Size--------------------------------Liquid depth--------------- ---------Capacity--•-------------------- f Disposal✓Field: Distance from nearest well__* -__----Distance from foundation-_-/0----------Distance to nearest lot line---�--------- Number of lines----------Z----------------------Length of each line---------- © - ----------:Width of trench..... oc�t✓ p �l a T e of filter material_-_, ------4<------Depth of filter material---Lif--____----.Total length------ --------------------------------- oA 1 f t � �l Seepage Pit: Distance to nearest well---r10--:.._------Distance from foundation----I-.a------_--.Distance to nearest lot line--S-._------- Er— Number of pits._--/--------------Lining material---�oe-_&.NSize: Diameter----3-3- Depth---Z-a.-----------I----.--_. p ------------- ----------De Depth ---------------------- ---------------------Liquid Capacity--------------------------- Cess ool: D;stance from nearest well--__-_---------Distance from foundation--------------------Linin material--_---------.-_-- ❑ Size: Diameter------- . p ----,--galiss . Privy. Distance from nearest well-._.____-------_-----,_.---_------------1--Distance from nearest building------______---.-.-- . LI' Distance to nearest lot line-- --- --------------------- ------------------------------------------------------------------------------------ ---------- I Remodeling and/or repairing (describe)-------------------I-------------- ---------- ------------------------------------------------------------------------------ ------------------------ ---- ---------------------------------•---•--------------------------------------------------------------------- - -------------------- -------------------------------------------------------------- --------------------------------------------------- -------------------------------------- ---------- 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 San Joaquin Local Health District, a (Owner and/or Contract (Signed -�' ?-------- ------------------------------------ ---------------------------- {Owor) )------------ 20 Qy:------------ --------Y---------------- --------------------------------------------------------(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 p f APPLICATION ACCEPTED BY---------------------------- - DATE s ' /---�f------ IREVIEWED BY------------- ------------------------------- --------------------------------- DATE---------------------------------------"------------------- BUILDING PERMIT ISSUED------------- --------------- — DNTE ---------------`--_---�--- -----------------------'- ---------- fAlterations and/or recommendations:__-----.- --------------------- -------------- _--- " ! -------------------------------------------------------------------------------------------- - ------------------------------------------------ I ----------- -•--------------------- - --------------------- --------------------------------------------------- '- y ---------------- --------------------------------- ---------- ------------------- ------------------------ --------- ----------------------------------- ----------------------------- --------------- . FINAL INSPECTION BY:-- ------------401 ---- �. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. • 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CG. 4