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FOIA OFFICE USE: �tP , .�� y� � r � ----- ---- -- -- - -__.______________________________________________.. LICATION FOR SANITATION PERMIT Permit No. ...11`�39. --------------------------------------------------------- (Complete in Duplicate) Date Issued ..-. .5 ------------------ ..__.------------------------- 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. JOB ADDRESS AND LOCATION---._-!`----...�.---- o,k Owner's Name !_. l_ ld�ii�.G ----- ---- Phone--------------------- r f .. zr� Address - <'✓� .Q....--••-.� ..- ----------------------------------- "., Contractor's Name- r= a�t7�` ` ' - ----------- --------- •------- --• . Phone._' �i. r - Installation will serve: Residence OKApartment House ❑ Commercial ❑ Trailer Court ❑ Mot ❑ Other ❑ y3; Number of living units: I-__- Number of bedrooms Number of baths _//-_-wLot size ------------------- 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 ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No El_" New Construction: Yes ❑ No B—_'FH /V Yes W?"""No [ C 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-_.-._...__......___----------.----_.__...--.---. ❑ No. of compartments------ -------------------Size--------------------------------Liquid depth-- ------ ---------------Capacity--•--------•.......... Disposal eld: Distance from nearest well__�Q...._Distance from foundation-2 .,Distance to nearest lot linea -.---- D Number of lines-----'.-.*)---------------------------Length of each line _' ' _.-Width of trench.___-- ___------_-_- Type of filter material_ Jp.L/_Depth'of filter material__-/�`_r_______Total length------ ------------------------ Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line----------------- 171 Number of pits----------------------Lining material--------------.--.----.Size: Diameter--------- --------- ---Depth--------------.------.__-----.-.- 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------------------------------------------ 171 Distance to nearest lot line ----------- ---------------------------------------•---•-----•----------------------------•------------------------------------- Remodeling and/or repairing (describe):_. __ ----- d._._... .,X_j__.S_.%1 --------- ,tom ---------------- - - ---- ---------- -- --- Ra �3c� - ------- --------------------------------------------------- -------•-----------------------------------------------------------•-----•------------------•---------••----------------------------•----------------- —10------------------------------------•-•--------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Irules and regulations of the San Joaquin Local Health District. (Signed) . ,g , / B --------- �� '`— -------------------------- ---- --- -- Title -- ------------ - - -. ner o or (Plot plan, showing size of lot, location/pl system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY R=@-'--------------------------- -------------------------------- DATE-------- n__75-7------�------------------- REVIEWEDBY-------------------------------_------------- -------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------- -------- ----------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------------------------- --------------------------------------------------------------------------------------- ----------- ------ -------------------------------------------------------------------------------------------- ------------------- ---------------------------- --------------------------------------- ------------- ----._ ---------------_------- ------------------------------- ---------- ---------e----- FINAL INSPECTIO Date---------- ------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxslton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.