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...................................................... _ ....................................... ...__.... . Am-LICATION FOR SANITATION PEF"r.J Permit No. ........... ! ......... ... ........ --------- (Complete-in Duplicate) 1/ / .............. This Permit Expires 1 Year From Date Issued Date Issued ..... ...1�/1�1-/ 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 AAD OCATION.---..... .� S - S I^E V E.N �O N• Owner's Name...._��--�-�_.._ °..- v`.V).�-�.0-S- ---- - --- - -....................................•--• - Phone-�'.�3"- --`-��- Address .�w - -51-.��...�I ..0...K.._..-----� ....... ........................................... ...... ---_---------•---•--_--•-•- Contractor's Name----- .�-.-e_-[f ................. Phone------ ---------------------------- Installation will serve: Residence [Apartment House ❑ Commercial [Trailer Court ❑ Motel Q❑ Other ❑ Number of living units: -. _... Number of bedrooms .2,- - Number of baths - Lot size �_f.. .71.n J.1.�' .l�.e_..S................... Water Supply: Public system [j Community system [I Private [i✓j"Depth to Water TableQ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [[Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-._. ) No P— New Construction: Yes P`_No ❑ FHA/VA: Yes ❑ No ff_ 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.._M2----Distance from foundation.-I.Cl-.........tfterLal -. n !�Y'.�..-!_.- .......... 0� No. of compartments-_-.- .._?77'�...........Size......M.00.i3.aj.....Liquid d pthh----- a p a c i t y .. Disposal Field: Distance from nearest well.... .O...Distance from foundation.-/.. -'io ._ .,Distance to nearest lot line.,4diql.-- Tytpebof filter of lines Length of each line..-. .._LOn. ...Width of trench_..`'..L4-....* - a pth of filter material....f tL`^'.�..Total length.....1 0 �...Pt,.................. Seepage Pit: Distance to nearest well._?-P.P..-...._Distance from foundation---.......Distance to nearest lot line... b.. .... Number of Its... . � f4`41 p �..............Lining materlal._.N.e_!� _ Size: Diameter... ` .. Depth-.�...__-.k....�a c "/e X I r I 9p, c Cesspool: Distance from nearest well ........._.....Distance from foundation. . ........... _ mLining atona ........-..._........_.......--...... ❑ Size: Diameter. .. ---- ----- ...............Depth- --- ---- - ----- - - - ...Liquid Capacity. • ----------------••---.gals. Privy: Distance from nearest well_................................_...-.._. -Distance from nearest building.-..-..................................... ❑ Distance to nearest let, line -------------------------------------.......................---------_-•---.......... ------------ ------------------------------•---- Remodelingand/or repairing (describe):.-..................................................................................... -------- ---- . . ........................................... .......... ................................. ............................-.......----------•----------...._.....----------- ------.........._............_... ........---•.................................. ---- -- • -- 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. (Signed)----- ....... ...... - _ .._ ---a,____�---•--------------------------.._ __.. . (Owner and/or Contractor) By:.........................................................------- ............I..........--...................--------_---__(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 1 APPLICATION ACCEPTED B .. ............. DATE.%�" ---�?-.7............... - .. .. REVIEWEDBY---- -------- - --- - ------------........._......._..................... ------------------------------------- DATE..... ........ . - --••-•-----...--••----------------------- BUILDINGPERMIT ISSUED . .... .. ..............•-•-..................._............_...---....---..._..........----------- DATE.-------- --- ........................................... Alterations and/or recommendations:-- -••........................................ .•--.._...--------------...---.............------•-----..............................._...........-----........ ................................. .................................................__._......_.._...............................rx.,.l '..._.....----...-•-------•--•.....--------......._------.........-----.._........ ......................... ........... ..................._.._...--- -- . -- .......................----------•------...---.'...................................................... .... ............................ ..... ............................------............✓...........:......,................................................................... FINAL INSPECTION BY:............ .. .. . Date....._...A_:. d,;7 ..... S � QUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 W s ak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi California Manteca, California Tracy, California E.H.9 2M 1-67 Vonguard Press