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FOR OFFICE USE. I ------ APPLICATION FOR SANITATION ---- ------- ----------------------------------- / ��!� Permit No. ---•--•---------- --- PERMIT - ---------------------------------- -------- (Complete in Duplicate) Date Issued .._7<l.�.kt - ------------------------------------- ------- ----------- This Permit Expires 1 Year From Date Issue - -------- --------------- --------------------------- Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. t -- ------------------•---------------•--- ... JOB ADDRESS AND LOCATION _...74-T-----S-,-- ------ Phone.._-f4Q.--- ... Owners Name___._ _ --�-- •--'---- - - ' �/ ----------------------------------- --•..__.---•--.... Address------ P .. ..__�. -------•-•-- --- # _... Phone...........k-----•--.......---•---- Contractor's Name------ •-- ---• -- Installation will serve: Reside6ce;91 Apartment House ❑ Commercial ❑ Trailer.Court ❑ Motel ❑ Other ❑ er,bof baths --__---- Lot size um ---------------------• ------------------- Number of living units: -------- Numkier of bedrooms __ Nf Water Supply: Public system N. Commuriity system ❑ Private ❑ Depth to Water Table ,�b ft, Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa,11 m ❑ Clay Loam Clay ❑ ❑ Previous Application Made: (If yes date_..__..__..,__..__-._) No� New Construction: Yes EA No El FHA/VA: Yes ❑ Na [I TYPE OF INSTALLATION AND SPECIFICATIONS: i R. (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) Septic Tank-.. Distance from nearest well_________________Distance from foundation_.______--____.----Material-___.__.________.________.___---.----:----------- ❑ o. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------------'•----•---- Disposal Field: Distance from nearest well- from foundation_.____..________.Distance to nearest lot kine_________________ ` Number of lines---------•------------------------Length of each line---------------------------- .Width of trench �® r _De Depth of filter materia -----------------------Total length-------•------.--------• Type of filter material------------------------- pr- r -h \� Distance from foundation _.__ ___.Distance to nearest lot gine__, ---_----- es Distance to nearest well_./.QLQ__------- D 6_- De th---- "t�f Number of pits--------/-----------Lining material_-,-Q- [� -----Size: := iameter__ � �p------- P Cesspool: Distance from nearest well-------------____Distance from foundation'--._______.__.____.Lining material____._.___-___.-___.-----------'als. 5 ► F1Size: Diameter.- ---. -------Depth-----------------------------------------------------Liquid Capacity----------------------------9 iDistance from nearest building Privy: Distance from nearest well------------------------------ -- ❑ Distance to nearest lot line--------------------------------------------- ---•-----------------•-- -------a � i Remodeling and/or repairing (describe)=------------•---- -- - ------------- - - --•---•----------------•-----------.__-------••-- •- -------------------------------- -- ---•- ------------------- 4 ---------------- ------------------------------ --------=---------------•- - - I hereby certify that I have prepared this appli cation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulat' ns of the San Joaquin Loc4l Health District. __._.(Owner and/or Contractor) (Signed)- `t v' ---------- --------- --------------------------------------------- ------------------ ------- --- - ------------------------------------------------------------------- Title ------ ---------------------------------- - ---- --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse si e. FOR DEPARTMENT USE ONLY DATE -------------------- APPLICATION ACCEPTED BY___ -- REVIEWED BY---------------•---------------- • --7 --------------------- --------- --------------•-----.. DAT ------------------------•--------------•-------------------- BUILDING PERMIT 155UEQ DATE -W- - - - - _ ----- - ------------------------------------------------- Alterations and/or recommendations--------------- ----- ---------------------- ------------------------ __ ---- k y _ } �, -------------------------- Date--- ! ---r-- 7_0----•-----6-- ------------------------------ FINAL INSPECTION BY:----j---------- - --- �InAQUIN i SAN LOCAL HEALTH DISTRICT 300 West Oak Street 124 sycamore Street 205 west 9th Street 130 South American Street Tracy,California Stockton,California Lodi,California Manteca,California ES-9 REVig EC 0•S9"'Co'2M 6-80