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FOR OFFICE USE: C APPLICATION Fpit--SANITATION PERMIT Permit Na. - -- -••� --- ---------------------- a- -----------_-- (Complefe-in Duplicate) • - -Date Issued _1�a::---_•• This Permit Expires 1 Year From Date Issue 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 Ord•snance No. 544. a �? �- -c •- t _" _ . C� { LOCATE = N . , JOB ADDRESS AND � . ---�- t Owner's Name------- ;' --- -------------•------=-------- - -----------------. ---- --- Pone------------------- --- --------- Address------- A_S__q-_CA--C>------ �+t2- �-Gt b4 --- Phone---------- ---- ------------------- --------Contractor's Name------ --u-2-IA----------------------------------• Installation will serve: Residence ❑ Apartment House ❑ Q �I1e Commarci I Trailer Cour} [] =Motel ❑ Other ❑ is �._ Lot size --- � '.eLI?+e�,!l.es� _. ---------- Number of living units. _ --- Number of bedrooms ---------Number o -------- Water Depth to Water Table 4-6 ft. Wa+er Supply: Public system ❑ Community system ❑ Private � p 9 ❑ Gravel-[]Sandy-L-Loa -9 -Clay Loam [I Clay C] Adobe Hardpan ❑ Character of soil to a depth of 3 fee+: Sand t I Previous Application Made:, (if yes,date" 1 'No [&- New Construction: Yes t& No ❑ FHA/VA: Yes El No M 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"".a_�?�""'Dis#arr`e frofn foundation- -_LQ"�.------Ma�+eri it""f U� 3L- -- __ - �._ _ Z" - !Si - _Li uid de th---- �Z. - --- CapacitY - F 'ompartments---- --- , ze "lC , .�__�---�-- Iq, i. Disposal Field: Distance' ounc tion_-"-I.0-.:--- Distance to nearest lot line----------------- D No. o c - - --- !from nearest wel4-"- .Q�.-. istane'tlofii f j ' Len th of.uaehline�" Width of trench._-""7xr----------------------- Number,of lines----------Zff----------- 9 ' 0-------- �. Total length------_E i0----=_ _- --------------- Type of�lie r material-_51. �Depth of filter, materi . f1 Seepage Pit: Distance,to nearest well--------------------I-Distance from foundation_------ ---Distance to nearest lot line--------.___---- 1 • r ` De th--- - - ----------- ' ❑ Number of pits---------- Linin material"✓+- {-" _-'-"�°_site: Diameter------------------- p Distance from nearest well_"_"=""-"""-_a_Distanc "-.Linin material_..-----.----- •----- t - 9 Cesspool: e from founda#ion- 9 Size: Diameter-------- --•----- (-Depth---------------------------------------- - ---Liquid CapacitYgals. Privy: y Distance frgm nearest well- _---- ---- '------ Distance from,ne`arest'buiiding_-----3" .�,-__ ------------- ❑ Distance,to nearest lot line--------------i__.--_ - ------'••------ --------- i I ' a ."- i ?"_-_" _. --""_""-.--_".. ------------------ Remodeling and/ r repairing [t�escribe�:-_.--- — I 4� ;, a'C -.. =Gj=��y-------------------------------------•----------------------- -=----�.�---• --•----------- ------------------------ t ---- ----_---- ---- ------------------------------- - i E �.� . ----------------------"--__--••__-___-._-"-�_-_•"""."_""_" ___"""-""""_"-....""---_-- ------------------------ - """ " _---•"""".__s 4---------------------"---------------------------------------- ------------_. O G I hereby certify that I haas� a pared this application and that the work will 'be done in accordance with San Joaquin County ordinances, State y and rre a+ions of the San Joaquin Lacal Health District. ' } : (Owner and/or Contractor) t or) -(Signed)---- By:---------------------- Title) ------------------------------ (Plot pian, showing size of lot, location of system in relation to wells,_buildings, etc., can be.placed on reverse side).. FOR`DEPARTMENT USE ONLY - DATE 9 m11- ;t K APPLICATION ACCEPTED BY""-- .-.__... 5------ • t BY-----------------------=--------------- ------------------ - -------------- DATE------�------------------------------------------------ REVIEWED -� - �� ------------------- DATE- - ----------- --------------------------f•.------,-----• BUILDING PERMIT ISSUED-------------------------------------------------- - ------------- e_ _ 1--------l-F „� - Alterations and/or recommen attons:."-.""-"- _-_ ""--_-- - .. ; t ------ ----------------------------- .... ,- ---------- r - '--'-'--'--- -- ----------------- ---------- J --- : ------------------------------------------------ -------------------- - --------- e ------` ---------- -- ----------------------- ------' " i . .... . Dat Q `" /--.� (�` .3 ---- FINAL INSPECTION BY--------------------= SAN JOAQUIN LOCAL HEALTH DISTRICT i t 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. : Lodi,California Manteca,California ! Tracy,California Stockton,California - f rt � E6 9 REVISED 6-S4 3M 3•'69 "'Co' l"