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FOR OFFICE USE: - j--- 5--- -~ -----v-- ---_ - _- G ._-.?_- ., v. APPLICATION 1=0R 5ANITATION PERMIT Fermi+ No. _ ------�i7,4 ------------------------------- ----'-W3 = ` 5 (Complete in Duplicate) / Date Issued ---------------------------------------- ------------ I This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct bns It the work rein described. This application..is,made in complianceA Cou 06 ff�� nty Ordinance No. 549. ..: JOB ADDRESS AN LOCATION.--------A'0A" ` Owner's Name_-- _-- -___-- .�-- v - ..-• ;x. - --------------------- Phone_.. Address---- 31> -----..-.�------ ------ - -- --• ------ - -- ------------------------------ ------------------•----- Contractor's Name_____ '--__._ _ _ Phone ---------------- ------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court E] Motel [:] Other Number of living units: -------- Number of•bedrooms _-----S_ Number of baths.___ Lot size _- !Jr ________________ Water Supply: Public system ["Community system ❑ Private ❑ Depth to Water Table 4/� t. . Character of soil to a depth of 3 feet: Sand ❑ Graver❑ . Sandy Loam ❑ Clay Loam,.❑ Clay ❑ Adobe�-lardpan ❑ Previous Application Made: (If yes:dote--------------------) No ❑[ New Construction: Yes o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) i 4,C, Sep#ic Tank: Distance from nearest well�_��1Distance from foundation-�40-_------.MateriaL. / ---------------_-_-----________--` ❑� Pof compartments Size_, 9,.S Liquid de th..... .................Capacity-S-0- No. r q P.Disposal Field:. 'D•stance from nearest well?24$. —_Distance from foundation---r/A. ........Distance to nearest to+'line------------? l ' Number of lines_____ ____________ Length of each line--__-3__u______fF------Width of french-----A-�____---__---_.._ T e of filter material.�t_ __De th of filter material-_-..l ---_-_-_.-Total' len th_________ _ .J YA P ` g _j----Y--�----- Seepage --- 7 Seepage Pit: + Distance to nearest well--pistanc -from foundation___14 _____.Dista ice to nearest lot line_ ____ ' Number of pits------ _________Lining material G� __.Size: Diameter.- �__ ________Depth____�`s J i Cesspool: Distance from nearest well----------------- from foundation-_-:.._________.__..Lining material------------------- ❑ I Size: Diameter f, Depth Liquid Capacity gals{ Privy: Distance from nearest well ____-------------------------------------------Distance from nearest building_----------------------------------------� ❑ Distance to nearest ]of line-------------------------- -- --------------------------------------------------- •------------------—------------------------------- Remodeling ----------------Remodeling and/or repairing (describe):--- �----------------------•---------- --------------------- N - ( f 1 ---•-------•---- ----- -------------------------- -------------- ----------- ------------------------------------------•------------------------------ �N ,. . I. ---------------------------------—-—---------------•--- ------------------------------------•------------------------------------- 7�, I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, to law , and rules and re lations of the San Joaquin Local Health District. I {Signed --------------- - 1- / {Owner and/orContractor BY:----------------- -- -------------- -tn ------ ------------------------ {Title �f �- o (Plot plan, showing size of lot, Iota+ire tion to wells, buildings, etc., can be placed o reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYy --- DATE -------------------------- REVIEWEDBY------- ------------------------- -------------- ------ ---------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------- ---------------------------------- DATE------------------------------ -------- ------ -------------- Alterations and/or reco ndations:::______ ._I_-__�---�.__6_?_-__________— �� - -`�c.__L`- _ —��' '` _ l"' mfg -------------------f------ CC ---------- ----------------------------- ------------------------ -------------------------------------------------------------------------------------:----------------------------------------------------------------- -----•--------------------------- --------------------------------------------------------------------------------------------- -- ----------•-•-------------------------------- ------- ------------------ r- � J FINAL INSPECTION BY:.-_,( / Date---- //// AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.c o. �Y