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FOR OFFICE USS. APPLICATION- FOR SANITATION PERMIT Permit No. t . -------------------------- ----------------------------- ------------------------------------------------- ---- --------- ----- -------------- (Complete in Year Duplicate)From Date Issued Date Issued --- Expires I 2-2-9—i io_ ©2 71�� ----------- --- - This Permit . T Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.e This application is made in compliance with County Ordinance -No. 549. JOB ADDRESS AND/y -------------------- < .......M_R NON f)N ... -- ------- Phone------------------------------------ Owner's Name__ ------I------- --------------- Address----------- TF—SCF)LC/\J -------------------------------------------- -------------- ---------2_:�------- ------------------------------------------------------------------ Contractor's Name_-T,-o_1).P_S------ -----------r--------------------------------------- Phone----------------------------------- Installation will serve: Residence 2--'Apartment House [3 Commercial E] Trailer Court E] Motel 0 Other El Number of living units: --_I_... 'Number of bedrooms -3-. Number of baths/---- Lot size ------ ------------- Water Supply: Public system C] Community system E] Private EJ/Depth to Water Table 357ft. Character of soil to a depth of 3 feet: Sand E] Gravel F] Sandy Loam E] Clay Loam [ff Clay F] Adobe E] Hardpan er- Previous Application Made- (If yes,date------- ------------) No E3 New Construction: Yes E] No El FHA/VA: Yes F] No D 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__��----Dista e from foundation-----10---------lylaterial__CQ - ------ No. of compartmenfs-...--2— X11:�,X'> Liquid clepth__�fA---------------Capacity_17?�n!2_0------- ----------Size__7_ Disposal Field: Distance from nearest -----Distance from foundation-----/0_------Distance to nearest lot Number of lines_________________________.._________._.- Length of each line--------------------- --____.Width of trench---------2 t�-_!---------------- Type of filter material---)FT0C6,___Depth of filter material------)-- -----------Total length-.-.-------ZOO ----------------- Seepage Pit: Distance to nearest well...Z01_,5-----------Distance from foundation-----/0--------Pi,f,noce, to nearest lot liri 1_1� Number of pits.-_.__2- ---- --------Lining maf4iria' l__)3_0 �..Size: Dianneter._'/_X..W.....Depth---------- ----------- T29 SANTA Cesspool: Distance from nearest well-----------------Distance from foundation--------------- _.Uning material___._-...._-_.._____________-___.-. El Size: Dlameter__J-----------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from n I earest well--.-.--- ----- - ---- -------------------------------Distance from nearest b�jilclinq------- --------------------- ----- Distance to nearest lot lire. -------------------------L, -----------------------------------------------------I---------------------------- ------------------------- Renriocleling and/or repairing (desc!ibe):------------------------------------------------------------------- ---------------------------•-------------------------------------------------------- 1: ----------- -----------------•--------------------------------------------------------I----------------*------------------------------------------------------------ ------------------------- ------------- ------------------------------------------- ----------------------------------------------------- ----------------------------------------- ---------------------------------------- ------------------------------------ --------4------------------------------------------------------ -------------------------------------I------------------------------------------------------------------------------- I hereby certify that I have prepared j6h--)Rpp'�ication nd that the work will be done in accordance with San Joaquin Courify I ordinances, State s, and K `ons'of the S n Joaquin Local Health District. in - as and r -- --------- ------ (Signed)-------- --------------- ------------------------V---------------------- ----------- ------------_--------------------)Owner and/or Contractor) ---------------------------------- ------- ----------------------------------------------- ................. By------------------- J ------------------------------------- --------------------------- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.', can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ----- ------------------------------------------------------------------- DATE---------- ....... --- ---- REVIEWEDBY------ ------------------------- --I----------- - ------------__---------------_--------------------------------------------- DATE----------------- '- BUILDING ATE---------------------BUILDING PERMIT ISSUED-------------I---------------------------------------------------------------------- ----------- - DATE----------------------------- --------------- ------------- Alterationsand/or recommendations:----------------------------------------- ------------------------------------------------------------------------------------------------------------------ - -------------------------------------------- ----9---- ..............--1------------------------------------------------------------------ --------------------------------------------------------------- ---------------------------------_----------------------------- ------- - --------------------------------------------------------------- - ------ ------------------------------------------------------------ --------------I——----------------------------------------- ----- ----------------------- ----------- -- - ---- ----------------------------------------------------------------------- ------ ------------ ----------- ---------------------------------------------------------------------------- ------------------------ -------- -- --------r------ - --- ------- ---- - - ------------ ------- ---- Tf FINAL INSPECTIQN-B.Y-- ... .. Date - ----- -------- r - ----- ------- SAN -------------------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hi Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, California L