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F R OFFICE USE: --�--------------------- - ----------------- ------ APPLICATION FOI�ANITATION PERMIT Permit No. . .tz� 114.3 ------ --- --- '-- ---- �------------------- - -- [Complete-in Duplicate) i ----- --------- - - ---------- --- 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 he work herein described. This application is made in compliance with County Ordinance No. 5 /r ri JOB ADDRESS A CATI U42 Owner's Name________ -__ e ° Address--------------------------------- .------------------------ Contractor's Name------ ---_ -•_ .. _ _._ ____---.--. Phone4&&_,9&-Z'7 _- --------�------------ - Installation will serve: Residence Apartment House ❑ Commercial [-ITrailerCourt 1:1 Motel ❑ Other El Number of living units: I----- Number of bedrooms -4-. Number of baths-1f----- Lot size -_7S �_._-__---_•--.-- Water Supply: Public system 9 Community system ❑ Private ❑ Depth to Water TableSO- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----_-------------- ) No ) New Construction: Yes ❑ No "--FHA/VA: Yes ❑ No 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 EffSU&4'1&r- No. of compartments.-------------------------Size-------------------- -------Liquid depth--- --- ------- ------- Capacity----------------------- Disposal Field: Distance from nearest well-VVIV.577 Distance from foundation- -- -------------Distance to nearest lot line__,:� Number of lines____471. _[(-- -._---_Length of each line--7-57 `tf Width of trench-�►f------ ----------- ----------•-- Type of filter material___ ------Depth of filter material *4 length-____7,5:_-- ,_ Gj -- ------------- Seepage Pit: Distance to nearest well------- ---------------Distance from foundation___._--__--_-____-..Distance to nearest lot line-----.----------- � ❑ Number of pits--- ---------- ------Lining material---------------- --- Size: Diameter-------- --------------Depth--------------------- ---------- pN Cesspool: Distance from nearest well --------- ------Distance from foundation_--------------- - Lining material---------------------------.--------- v ❑ Size: Diameter- -- --- ---------- --- --- ----- Depth--------------- -----------------------------------Liquid Capacity- ------------ -------------gals. Privy: Distance from nearest well _--_--------------------------------.--__----Distance from nearest building.----------------------------------------❑ Distance to nearest lot line --------_----_---.--_------------ -- Remodeling and/or repairing (describe):---_- ' - I hereby certify that I hav epared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r es d regulations of a San J aquin Local alth District. (Signed)--------------- ------ ------ --- - -- --- - -- - , --- - ---* --- - -- -- ti- - - --- ---- --------------- -----(Owner and/or Contractor) By--------------------- - -----(Title)---- �onre:verse ------ I plan, showing size o iot, location of system in relation to wells, buildings, etc., can be place side). F ARTMENT USE ONLY APPLICATION ACCEPTED BY--------- L - - -- - -- - -- -- --- ------------------------- -----------._ DATE-- --- --��_--}-�-_-�-- REVIEWED BY---------------------- ------------ - - ----------------- ---- -- -- -- --- -- - ---------------------------- --.___ DATE PERMIT ISSUED__--__ ----- ---------------------- -__- __- -- DAT- --- ------------------------------------- - Alterations and/or recommendations:____ - _- _ �� -- ------------------------------------------ - -------------- ---------------------------------------------------------------------------------------- ---- - -------------- -- - -- ------- - ----- -------------------- - ------------ -------- FINAL INSPECTION BY:---- Zo:�U --------------- Date------/,5S IN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca,California E.H.9 2M 1.67 Vanguard Press Tracy,California