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/ 11 IGI 1 ____.J _______________________ 3APPLICATie� FOA, SANITATION PERMIT Permit No. - --------------------- --- ----------------------`.._ (Complete in Duplicate) Date Issued -------------! This Permit Expires-11 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----- s—------ c-.--r___O' �cv�e -------------- i Owner's Name ; L GL _r+ 'K -------------------------------------------------------- ------------- -- ------ ------- Address----------- l�----------_----------------------------------------------------------------------_....-_.--•--------------------------------- Contractor's, Name--------- ------•--------- ------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/---- Number of bedrooms __Number of baths _1..__ Lot size -------------__________________ Water Supply: Public system E] Community system 0 Private E] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Clay Loam I] Clay ❑ Adobetj—Hardpan ❑ Previous Application Made: II(If yes,date.......... ..) No 0 New Construction: Yes ❑ No ,E] FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Ta Distance Ifrom nearest well Distance from foundationMaterial i No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- Disposal iel Distance'from nearest well.Nts .P..._.Distance from foundation___!a----------Distance to nearest lot line--- Number f lines------(�---- -----------------Length of each line----------��............Width of trench-------- T 2--` -`f------------- I yp filter material jtk �-� Depth of filter material-__--1�-11_.----_Total length_--- --__ - � _- - - --------------- p 9 see a e Pit: DistanceJo nearest well_._sl/a1C -----Distance from fou alaaton__-,`______.Distance to nearest lot Number of pits.____.-1_.______---Lining material_ 114 - .. lze: Diameter.----------------------Depth.. 4 Cesspool: Distancelfrom nearest well-----------------Distance from foundation--------------------Lining material_____________________________________ W ❑ Size: Diameter----- ----- ------- --- ---- -- -Depth- ----------' -------Liquid Capacity----------------------------gals. � Privy: Distance"ifrom nearest well„----------------------------------------- --____Distance from nearest building---------------------------------------._. W ❑ Distance!to nearest lot line------------------------------------------------------------------------------------------------------= ----------------------------------- . Remodeling and/or repairing (describe) ---------------------------- -- __ ----------------------------- - -----------------------------------------------17----------------•--------._...-.- ------ ------ ------ ----------------------- ----------------------------------------------------------------------------------------- I ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- 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 regulations of the San Joaquin Local Health District. li (Signed)--- t'7---------------�f”�-��,�l-Cly-v—------------------------------------------------------------------------------(Owner and/or Contractor) }0 BY= --------------------------------------------------------------------------------------------------(Title)-----...�..��-� G (Plot plae, showing size of lot, location of system in relation-to wells, buildings, etc., can be placed on reverse side). �i. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ---- ,/ --------------------------------------- DATE------ 114 6'r� REVIEWEDBY---------------------- q-------------------- ----------------------------------------_-----------7------------------------- DATE----------------------------------------- -------------- BUILDING PERMIT ISSUED--'!---------------------------------------------------------------------------- '-------------------- DATE------------------------ ----------- ------------ ---------- Alterations and/or recommendations:-----------.------ --------------------------=-----------------------------------------------•--------------------------------------------------------- ---------------------------------------------------i---------------------------- -------------------------------------------------------------------------------------------------------------------------------•--------------- I! ------------ ----- I '.:. FINAL INSPECTIONBY:.I� _. �'. �.�-- Date....____'�_ � � SAN JOAQUIN LOCAL HEALTH DISTRICT I : 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Il Lodi,California Manteca,California. Tracy,California F.F.CC. II f