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FOR OFFICE USE: --- -- ---- -----_� -� _._____________________42.&M-4 � 1 AP ICATI N FOR" SANITATION PERMIT Permit No. -7 ---------- (Complete in Duplicate) !� �' 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 the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION..._/6 _ Owner's Name - 4 M�4 1� 1 - 1 l �Lt1"�!'�------------ Phone---------------------_-- Address-------f'--pd-- w ......A.G { ------------------------------------------------------------------------•----------------------------•------- Contractor's Name ----------3- r-S- -------------------------------------------------- -------------------------------------------------------- Phone.---- ............................. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __'1----- Number of bedrooms ___,._ Number of baths J_____ Lot size ------+ `3-X- ,3______________________________ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table __ elft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 21' Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes []/11To ❑ FHA/VA: Yes ❑ No 2— 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---!7=-----Distance from foundation__/_-©------------Material_4 64_ ----------------- ----------- [B/ No. of compartments----.`Z------------------Size..._ depth__-'9__ .____--___Capacity.___1�00_1 Disposal Field: Distance from nearest well___,_`----------Distance from foundation.-,,-----------------Distance to nearest lot line................. F-1Numberof lines.__-_-*�_____----------_--------Length of each line__7".d'_`___6.0_____..Width of trench.--a:g "_______._____-_---__ Type of filter material IRP-L_Ir_____-.__Depth of filter material_ 8" -.__-____Total length___ -____________________-- Seepage Pit: Distance to nearest well______--__:________Distance from foundation---l-4!-----------Distance to nearest lot line--- _--____-. P --------- g 4.. Depth �- ------- . Number of its____.__ Linin material Diameter-___. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material __-_-______.________-____________. ❑ Size: Diameter----- --------- - ----Depth-------------- -------------------------------------Liquid Capacity------------------------...gals. Privy: Distance from nearest well----------------.-------------------- ----------Distance from nearest building______--________________________-__-_. ❑ Distance to nearest lot line------------------- ---•------ ------------- ---------------••---------------------------- ---------•---•----------------------------------- Remodelingand/or re airing (describe):--------------------------------- -----------------•----------•--•--------•----------•---- -•--•----•--------------------------------•-------•---------- ------------------------------------------------------- -------------------------------------------------------------------------------------------------•--------------------------------------------------------------- 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 regula 'ons of the San Joaquin Local'Health District. (Signed) ----- -------- ------------------------------------------------------------------------------------------------------(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). A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - ----------------------- -------------------------------------_ DATE-----------1---'---I--�----,e7 --------------------- REVIEWEDBY----------------------------------------------------------- ----------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------.. DATE------------------------------I--------------------------- Alterations ------ --------------------Alterations pnd/or reco m-ie-nada)'tio1n�s'-__v__-___________--__-_'_�__'_c_,_•___--_-_-_-__-_____________Q_l_(._ __ ---------------------------------------------- ------ -- - �fZ= _ � - --- --- -r--:.-.----•------:-_-t-!•_----------+-^------------ r'slrf,---•-- ,. J0ff "----- ' : _. FINAL INSPECTION BY:..--------------- ---------------------------------- Date--------- _ ---------- -------------- 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.00.