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FOR OFFICE USE: ------------1. -7 APPLICATION FOR SANITATION PERMIT Permit ----- ............ --------------------------------------V------ ------- --- (Complete in Duplicate) Date issued ,-.L/-J55 --------------- -2-------- ------- ------------ This Permit Expires I Year From Date Issued Application is hereby made to the Son Joaquin Local Healfh-Districtfora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION--4,3±�7_co___ ---------------------------------- ----------------------------------------------------------------- - --------------------- ------------------------------------- --------------- Owner's ---------- --------- Phone----------------------------------- Address__ ------P------------ --- *%� ---------------------------- ----------------I----------------- ------ -----------I-------------------------------------------------------------------------- Contractor's Namrm ---------------------------- -------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence g3---;6;parfment House E] Commercial 1P_�Trailer Court E] Motel F] Other E] Number of living units: Number of bedrooms _-L Number of baths 1---- Lot size ....? x_.3_q0------------------------------- Wafer Supply; Public system ❑ Community system F1 Private P!rDepfh to Water Table A_`5' ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay [] Adobe B—Hardpan El Previous Application Made: (if yes,d cite. No New Construction: Yes �No ❑ FHA/VA: Yes Ej No [r— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or"cesspool permitted if public sewer is availablewithin200 feet.) Septic Tank: Distance from nearest well-v42.0--------Distance from foundafion-ZO.'e Material-------- ` ---------- 0__1_ No. of comp'arfrnerifs-;Z---------------------- /---Liquid dep�h___-% ------- ------------- ---------capacify__� Disposal Field: Distance from nearest well.0-:U--------Distance from foundation---A0---------Distance to nearest lot line____-__----- Number of,lines------9—------- -- -------------Len'th of each .--.___.__.Width of trench----_9r,._`:_____.-__________ _-�f_._` 9 .1 ------------------- Type of filter- material! '7&AAC--------Depth of filter material_Jr----------------Total length-----11s-0- iStanCe Seepage Pit: Distance to nearest;Wei I_1a,0- ---------D from foundation---/a-----------Distance to nearest lot line----------------- Number of pits... 12�—----------Lining mat e Size: Diameter--- ------------- f Cesspool: 7'�6isfance from nearest well__---------------Distance from foundation____----------------Lining material------------------------------------ 4 e F ize E.-Pia mete r--------t----------------------------depth-------------- - --- --------------------------Liquid Capacity---------------------- ----..gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------- ------ ❑ uilding------------------- ------- ElDistance to nearest lot line- ---------------- --------------------------------------------------------------------------------------------------------------- i Remodeling and/or repairing (describe):--------- ------------------- ------------------------------------------- --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- ----------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and fhaf_fhe work will be done in accordance with San Joaquin County 'ordinances, State law and rules and woulati s of the San Joaquin Local Health District. (Signed)-------------CZ------------ --------------------- -------- --------------------- -- ---- ---------------------------------------- --------- ------(Owner and/or Contractor) 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-.: DATE_ 4/4 6 --------------- - --- ------------------- REVIEWED BY------ ------ -------------------------------- ----------------------------------------- ------------------ ------------------- DATE---------------------------- BUILDING PERMIT ISSUED-:----------- --------------------------------------- ------------- -----------------------t.. DATE------------------------------ AlferafionsA�nd -3. — ------- Lor recommendations:........I --------- ------------- .......... ------------------ ----- ------------ --------------:cf-------- -------------------- ---------- __---- ------ ----v,- ------ - -------------- - -------- ------------- ------ C17-1_1_-�------) -ct,—,W� - ---------------- ---- ------------------------------ -_1 . ......... -------------------- -- ----- ----- ------------------------------------------� / I -- ------------------------- --------------------- ------------------------- ----------- ---------- ----------------- -----------------7 .... -- ---- -------- -- --------------------------------------------------------------- -------- ---------------------------- -------- FINAL INSPECTION BY:.-----e�< rDate --------------------- ---------- (K--------- ---ANJOAQUIN LOCAL HEALTH DISTRICT 1601 E.Huxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California' Lodi,California Manteca,California Tracy,California F.RC0.