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FOR OFFICE USE: ---------------- APPLICATION` FOIA' SANITATION PERMIT Permit No.4920Z�� 0--------------- ------------- --1----------------------- --- (Complete in Duplicate) Date Issued ---------- ----------- ------------------------- --------- 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 LOCATUOK.- - - - -------------------------------------------- -S 7_ ...... . Owner's . ... -.-- . ---- - ---------------------------------- 4 Address------------------- . .......-------.................................... Ph one.................................... moi C Contractor's Name------- ---- ---- ---- --- --- Installation will serve: Residence ❑ Apartment House M, Commercial E] Trailer Cot.irt E] Motel [] Other E] Number of living units: ---2--Number of bedrooms __''Number of baths ---710t'Rs?te ------------------------------------------------------------ Water Supply: Public system g Community s tl Private El Depth to Water Table -------- ft. 9.4="D m Character of soil to a depth of 3 feet: Sand Gravei'l F] Sandy Loam Ej Clay Loarq E] Clay Ej Previous Application Made: (If yes,date--------- ---- No E] New Construction,: Yes L) No r_-1 FIS A: Yes 0 No 5 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)-; i Septic Tank: Distance from nearest well------------------Distance from foundation---- _Material_----- --------- ------------------------- El No. of compartments------------- -----------i Size--------------------------------Liquid clepth------------- ----------- apacity----------------------- --- -- Disposal Field: Distance from nearest well---- '--. 'Distance from founclation__�---- . ......Distance to i wrest lot line------- ------- 171 Number of lines_-_ -Length of each line______ 495��---` _J!._Width ---- ----Z------------- -Depth of filter material----- _ /0'*�1,.-Total Type of filter e OL-------- 4 --------------------- Seepage Pit: Distance to nearest well----- ----------------Distance from foundation..........._j......Distance to est lot line_--__---_--_-_-.- S 171 Number of pits----------------- --Lining mate ------------S*e: Diameter------------- h--------- -- ---------------- Cesspool: Distance from nearest well---------- -------Distance from foundation---------------------Lining mate -------------I---------------------- ❑ Size: Diameter. --- --------------- ----------------Depth------ --------------------------------X-Liquid Capa Y- ---------- ---------gals Privy: Distance from nearest well______________________;_-_...-_--___.--.-_I ----Distance from nearest building ------ _----_----_______--.-.--__-.-. ❑ Distance to nearest lot line-- ---------------------I--------- -------- -------------------------------------------------------- -------------------------------------- ppiring (clescril: Remodel g and/or,re ),e): -------�1_4�z C��-—----- ----------------- ------------------------- ----------- ---- -----449 74------- e-------_- ----- --- ------------------------ -------------------------------------------------------------------------------------------- -------_--_------------- -------------------------------------------------------------------------------------- -------------------------- ---------------------------------------------------------- ------------- ---------------------------------- ------------------------ ----------" one in accordance with San Joaquin County ----------------- -�e I hereby certify that I have prepared this applicati'n and that the 'or 9 * i� ordinances, State laws and ruIS"nd regulations of the San Joaquin Loci Health Mrief.11 (Signed)---------- -------- ----- ----- - ------ ------------i.------------------(Owner and/or Contractor) By:----------- ---- -------__1----------------V--------------------ia,_tffitie)------- ---------- ------------- -- -------------- (Plot plan, showing size of lot, cation of system in relation to wells, buildings, e , ca_#%e';placed on reverse side). F05�?EPARTMENT USE ONLY APPLICATION ACCEPTED,hY.....T_-1-R.-0--------V--------------- ------------------------------------------- DATE------11,14!9_15 46-46----- ----- REVIEWEDBY-------------------------------------------------- ----------------------------------------------------------------.... DATE.......r----------------------------------------------------- BUILDING PERMIT ISSUED- ------------------------- --------------.DATI�----4--------- -------------------------------------- Alterations and/or recommendations:----------------------------------------------------------- -- --------------------------------------�Y'_ -------- --------------- --------------------- ------------------------------------------------ ----------- ------------------------------------------------------------------------------ - ------------ ---------------------------------------- ------------------------- ------------------------------------- --------- --------------------- -- -- - ------ ---------- -- ------ ------- -------------------------------------------------------------------------- - ----- -- --------------------- --- ------ - ------------- ---------------- -------------------------------------- FINAL INSPEC --- - ---- ----- ------------- - Date_----- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.