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FOR OFFICE USE: ............ ---- ......._._N- .................................. . . ........... APPLICATION ;OR SANITATION PERMIT Permit No. -- . - -- (ComplOst-in Duplicate) Date Issued _.-..... __ .... ..... - _.____........... This Permit Expires 1 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. Gm � 1rSi ��F / � � .._..__.._......JOB ADDRESS AND LOCATION. ... .... .. GA . . _ Owner's Name--------- / ----------� ........ - Phone.................................... Address......... -----S ..... ..... ---- ..------- ..... .................. . Contractor's Name...........14,7l{�--~ pQ r -- ---- ----.- _............. -- - -- ......... Phone-.................................. Installation will serve: Residence ❑ Apartment House ❑ Commercial p Trailer Court 1 Motel ❑ Other ❑ Number of living units: . .. Number of bedrooms rL/ . Number of baths _.. Lot size% _",* ---- ---.---.------ --- ------.....-- Water Supply: Public system ❑ Community system ❑ Private Ae*`DDepth to Water Table/w ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ j Previous Application Made: (If yes,dote........__.._.. ) No Ir New Construction: Yes ET�No ❑ FHA/VA: Yes @;-�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r / Septic Tank: Distance from nearest well DO _ Distance from founds ion�u' _------- Ma��al�`CG f __......._. �r No. of compartments...-.2.......---.......Size.a�X3..:?a-Liquid depth.'r�..Z....... ._.... Capacity__OQ Disposal Field: Distance from nearest well. 47..e-Distance from foundation...la.....---Distance to nearest lot line..P........... Number of lines._.__..��.__.. Length of each line.. _P er.................Width of trench-.rZ-�..._........_._....... ..�............. - i/ ype of filter maferiaLz�O....;1*-Depth of filter material..../.''.........Total length.l��...............:......... Seepage Pit: Distance to nearest well................._._Distance from foundation....................Distance to nearest lot line------ .......... ❑ Number of pets... ................_Lining material..................... Size: Diameter....................... Depth___._......._..------....._ Cesspool: Distance from nearest well ................Distance from foundation..... .......... ..Lining material.. ....._-----------............_ ❑ Size: Diameter. .. ......... ..... ................Depth..........--------------_ -----------------..Liquid Capacity............................gals. Privy: Distance from nearest well..................................______._Distance from nearest building------------------------------------__.. ❑ Distance to nearest lot line-----------------------------------------------------........_....-------------- �-+---------/-................................_...... Remodeling and/or repairing (describe):..._..nQ.�...J�.'dpi /.. ....ed.^t�--.w`... C./r?.7..../...'d. ' .._/---._ .....--...... ...........................`--..._......-_..........---................................-------------_.........-'---.............-'----'-----..................................................... ---------------- - --------------------------------------------------------------------------------------------- I herebcertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Late laws, and rule's and regulations of the San Joaquin Local Health District. (Signed)_--- ��L-�r _ _I/�T� �.....-../....(O GF I�Or Contractor) By:....................---............ --_..... . ........ ,.'f (Title)fs� ------- .._.... _....... !�� - - . . _.. .... .. (Plot plan, showing size of lot, locafio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__,. ;& ....................................... DATE_(.>77a__!6_ :...._...................._. REVIEWEDBY...................------ ------------..._..._- _.......................------- — - .- -- ------------ ----- DATE...........-----------------..... - - ------------ BUILDINGPERMIT ISSUED........ .. ........................._----------.------------_................___--------.------- DANE---- ----------- - - ............................. Alterations and/or recommendations: .............. .. -- - - -------- ---------------------- ............--`--............------------------ -------------------------- ---------------------------------- -------------------------------...._..._------------ ------------ - ---- _ ---- ..... .. ---- .................................... . -- ... -- ------------ -- ------------- ----- ---------- ----- --------------------. ............................................------ ---------- -- ........................------------------------- - - --------- -------------- -......... - .. . ................................. ....... ....._.................._................ . ........._.........._... — -- - - -------- -- ---------- -----___..... .................I.......... _....__........._............_._........................ ............ .---------- -- ----------------......... .......................................................... FINAL INSPECTION BY:.. . ...... ... ...........------_- Date_ .-fO..g...._. . ... - .------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hacelten Ave. 300 Wert Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press