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- r FOR OFFICE USE: /?/ 'ea e, Permit No. .... 71�..... - (CATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued .,1�3-��C-�- ------------ - +� � / _-----__-___._._.__. 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. �, / G �s �1 C / �' '�''''------------ JOB ADDRESS AND L CATION...._--------------- Owner s Name..-- --t-•--- --- ----_ - --- -------------------- ------------ ---- Pho1Se__._.--------- --------------------- Owner's Z- -- .� � Contractor's Name-------- -------- � -------- ....aQ'-- Phone-------•- • - ----•--------•---------•-••-- ---------------------------------------------- -- - Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Y/a< / Number of.living units: ___-- er of bedrooms _._____ Number of baths - Lot size Water Supply: Public system Community system ElPrivate E] Depth to-Vater Table7- ft. f soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand oam ❑ Clay Loam ❑ CI Adobe ardpan ❑ Character o p Previous Application Made: (If yes,date-_____-_____-_._) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No P TYPE OF INSTALLATION AND SPECIFICATIONS: 0 feet.) (No septic tank or cesspool permitted if public sewer is available within 20 ,,/e Septic T __Distance from nearest well------ �______-_-Distance from founclation� -_--__-.Mat *al_._ = No. of compartments____ _______________Size. _ -- �1� Liquid depth Capacity..f Disposal eld: Distance from near st well----- _.._Distance from foundation-_--//l0-�--.Distance to nearest lot line_._�_...... Number c. lines___a__.__�__..- __ _Length of each line---- O �_. ._-Width of trench ------------- ' g ,e Type of filter mate nal__�_/s.____.__�.)!Depth of filter material len th_.� / / Seepage it: Distance to nearest well------ `.___._Distanc om foyndation__,� .........Distance to nearest lot line.... --•----. .��jj / Number of pits_f _.___---Lining material. -6-(-- _-___Size: Diameter.,.�_3__��___..__Depth_.o�.� lt' L------•�, Cesspool: Distance from nearest well-----------------Distance from foundation------.-------------Lining material-----------.__.--------------- als. 171 Size: Diameter--------------------------------------Depth-------------------------------- ------------------Liquid Capacity------------------------ 9 Privy: Distance from nearest well ____-______________.__--_-__----------.---Distance from nearest building___-___--.__________________________--. ❑ Distance to nearest lot linYe---1---�---'-------------- ----------------------------------------------------------- ---•-------- ------------------ Remodelin d/ rePaiig (describe)__ ------n� ---- lC----ls_- ;T_'N ------- v. --------- - ---------------- -------•----------•-------------•------------ -------------- -------------•------------- --------- ------------• - $- ---------------------------------A -------------------------------------------------------------------------------------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 relations of the San Joaquin Local Health District. ------------------------------------------- ------(Owner an or Contractor) --- -- -- ------(Title)------ - ---- -- ---- ----- (Plot plan, showing size of to , to ation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - --------------------------------- DATE-----, ------ ---�y,----- ---------------- REVIEWED BY_.. ._ _. ---- ----------- -------------------------------------- DATE---------------------------------- ------------------------- -- ----- -------------- ---- BUILDING PERMIT ISSUED --_ TE.. ----- -- 717 _1- - -------•------•---•------------• ------ Alterations and/or recommendations:__1 � Y �'� ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ----------- --------------- --------------------- -- ----------------------- -------------------- ------------------------------------------------------------------------------------------------------- - FINAL INSPECTION BY:---- __A• -------- -------- Date -A0Z ----------------------------------------- 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.C C.