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---------------- ----------/4-F-------- A _ICATION FOR SANITATION PER, Permit No. ------ --------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued --- -------- ------------------ -7------------ 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 AN3 IOCATIPN.. 6 .... ......... ... . ...........----------------------------- --_--------_ aeZ4l ------- Phone_..---.......... ............Owner's Name...... - - - - Address.......... ........ -------5Z>,-,J_Q ................................................. Contractor's Name.. .......................................... Phone...........---------------------- Installation will same: Residence [J,/Apartment House ❑ Commercial E] Trailer Court [I Motel D Other 0 Number of living units: ----)---- Number of bedroon-4?X.. Number of baths Z---. Lot size -----CZZ4445w_�---------------_---_- Water Supply: Public system El Community system C1 Private R�`Depth to Water Table 6e_*7 ft. Character of soil to a depth of 3 feet: Sand EI Gravel [] Sandy Loam 0 Clay Loam El Clay 11 Adobe LL,41arclpan 0 Previous Application Made: (if yes,date--- -- -- ---I No 2, New Construction: Yes E] No 0/ A/VA: Yes E] No L_— 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._..-.------.._Distance from foundation-------------------Material------------------------------------------------ AYror/-4/5 No. of compartments-------------------------Size.........................._.Liquid depth-------------------------Capacity..........11 4-- Disposal EW& Distance from nearest well /-aw-'O'Disfance from foundation--..f/or........Distance to nearest lot Nu 6 r of lines_.......... ---Length of each line---,.SO-------------- ----Width of trench..aD_4�--------_---- 1-1............Total length........-.--_-.._-----.I....... slili�of filter material...1-71-- -------Depth of filter material SeepagS,PO-. Distance to nearest well-IDO. . .. .....Distance&om if unda+iorl__/A1__!.... ance to nearest lot lie. :_..,____-- V umber of pits------I--------------Lining material--/ - ---------Size: Diameter Dis., -------- -- - - ---------- UK W__ --- --------- Depth-;?9. IMJ�t/of!l Distance from nearest weH.-.-.------------Distance from foundation----------_------Lining material-.-..---__-..-....---.-._-.-,----. v ❑ aterial----------------------- El Size: Diameter----------------- ------------- Depth-------------'----------- -------Liquid Capacity.....___----------_---gals. Privy: Distance from nearest well----------------- -----------------------------Distance from nearest building.-....--_------.--.---.--_._.---.-.-. ❑ uilding--------_-------------------------------- 0 Distance to nearest lot line------------- ---- ---------- --------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-..-------. ..---------------- ......._------ --------------------------I-------------------- --------.---------------------------------- ----------------------------- ----------------- ------- ...................................11---............---------........----------------------------------------------------------1------------------------------------------------------....---- --- -------------- --------- -------------------------------------------------------.........--------------------------I------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work-Will be done in accordance with San Joaquin County ordinances, Staftriaws, and rules e ttions of the San Joaquin Local Health District. -- ---- ----------------------------------------------------- F----(Owner and/or Contractor) (Signed)---------IZOAl ---------- --------------- BY:----------------------- - (Plot plan, showing size location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----00 1>•oke'sc r-- ------------------------.......---------------'------- 5------------------------ REVIEW -----------------------_ REVIEWEDBY---- --------------------------_-------------------------------------------------- ------------------_---------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------.--------------------------------------------------- DATE--------- _---------- ---------------------------- -- Alterations and/or .........&------- .......15&0�----- .........---------t_...AS0h* ------------------------................I---------------------------------------- --------------------I------ --------------------------------- .................................................... -------------------- -------------- ------------------------------- -------------------------------........................................---------------------------------------------- ---------------------- ----------------------- ----------------------------------------------------------- ---------------------------------------------------- --------------------------------- ' --------------------------- ------------------- --------I----- ----------------- -------------------1---------------------- -----------------------...........------------------------------------------------ FINAL INSPECTION BY:- T_13;vos ..____._.- Date---1 qg-� -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.H.selt,m Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Sir.*, Stockton, California Lodi, California Manteca, California Tracy,California