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FOR OFFICE USE: ----91st-�------------�-=�-�----`�- -- - APPLIC-ATIOM FOlt SANITATION PERMIT Permit No. .1.p37 ------------ 4-VI-_ - ------- (Complete in Duplicate) Date Issued _71-62 -..--__.JJ//�6 ------------ ___ __________ ___________ _ _ __-_- _____. _ I 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. L/ JOB ADDRESS AND LO ATION-. --------------------------------` U-7 H AS `T -- ---------------------------------------------------- Owner's Name ------- /9 �---------------------- ---------- `-------------------------------- Phone.-Ah:----- 4�711Address-------------------- ........--1-�---�-�-........�---'`---�---------�._---------------------------------------------------------------------------------------------- Contractor's Name------ �`�. � ^� k ----------r------- c-J •--•------•----•-------- Phone . Installation will serve: Residence 04 Apartment House ❑ Commercial ❑ Troiler Court ❑ Motel ❑ Other ❑ = r Number of living units: _j--- Number of bedrooms ._2_ Number of baths _____ Lot size _-O_o___.x __ __ ___I ___---------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IX Hardpan ❑ Previous Application Made: (If yes,date______ ---------.) No 16 New Construction: Yes ❑ No g FHA/VA: Yes ❑ No Q 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_/,Ut�_Dis#antg from fo�indation----�l�_._-___.Materia�l____ ��'� __________________ [ No. of compartments 7/ __ Size �'i X `� --------Liquid depth___$_2.--------------Capacity.. _!-____ *� Disposal Field: Distance from nearest well N-f?-M7 Distance from foundation];$�__-.___-Distance to nearest lot line----------------- [� Number of lines------------------_____________-_Length of each line____-____;___-___________..Width of trench__.--------__--------------------- Type of filter material_j_l--- _ KDepth-of filter material__IS___.--------.Total length_____--V0--__-_____________________ 3► Seepage Pit: Distance to nearest well__A9Q&957__Distana� from foundation 7S_.........DDist�I a to nearest lot line_ �._.... w rx Number of pits_f&� Cl)- _ _ 4ining mate biameter______ __ _________Depth____-____-- Cesspool: Distance from 'nearest well---- _------------Distance from foundation--------------------Lining material.____________-________________--. Size: Diameter.;-_. .-------------- __° Depth--------------------------------- ------------------Liuid Capacity--. gals. Privy: Distance from nearest well----�4----------------------------------- __ _Distance from nearest building________________________________-_. s ❑ Distance to nearest lot line !_:, --- eX t 5 ��Rem elfing and/or re airin (describe): �Q....... �V --- --- itrf JC.------------------------ ------------- --lJ______________---- -- -------------------------- ----------- ---- ---- _---------------------------------------------------------------- .-----------------------__-. -_-____-____________y ____--___-__________ -________ _______-_--.-_.__.___-______-__.--------------- --------- ---------------------------------------------------- _____-. _-_________________________________________________________________ _________________________________________________ I hereby certify that I have ptepared this application and thiat"the�Work will°'e done in accordance with San Joaquin County ordinances, State laws, an d regulation(s�of the San Joaquin Local H�,eaglt District. (Signed)-------------- -- ------- -- --' _ (Owner and/or Contractor) By:-------------------------- Q----------- ----------------------------------------------------------(Title)----- - ---�'------------- -- -------------- (Plot plan, showing size of I"o , location of system in relation to wells, buildings, etc., can be plac9d on reverse side). F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- -- ----------- DATE _ = ! REVIEWEDBY---------------------------------- - --------------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED ----- DATE--------------------------------------------- --------------- Alteraf ss and/or recomme /*Dations:------- ------------ ---- ----- ------------------------- .7` � ---_ 1-t--•------ `•` - ( cQ ----- - --------- ------------------------------------------------------ ----------------- ----------_----------- ------------ --------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Date - >' / -- ------ FINAL INSPECTION BY:----- - - ------- f � l/j SA IN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.