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FOR OFFICE USE:�'�7 jJ -- -- Permit No. ./77-_..�. EZ -� . � � APPLICATION FOR SANITATION PERMIT - (Complete 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. 544. JOB ADDRESS AN3 LOCATION T f� -�... --C�--IQ // "� ----------------------------------------- Owner's Name------------- _.------- 14-0-13-��-- - Address •.._.. E - ----------------------------------------•-------------------------- ----- _1m ..... Contractor's Name---- ,S 14 - ) --t-----.---- Phone----------------------------------- Installation will serve: Residence Lam, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ '_Zt— Number of living units: ___I____ Number of bedrooms --3-. Number of baths ____(-_ Lot size __' ____ " ----------------------•----------- Water Supply: Public system ❑ Community system ❑ Private ;Z Depth to Water Table _./_at. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑' Clay Loam ❑ Clay ❑ Adobe l Hardpan ❑ Previous Application Made: (If yes,date--------- ----------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ Nog TYPE OF ]INSTALLATION AND SPECIFICATIONS: Ji T_ 7 (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank Distance from nearest well________________Dis#ante from foundation__._-__ __--.Material__ �__________ .___._-_______--__._________-- ❑ � No. of compartments------------ ------------Size-------------------------------Liquid depth Capacity Disposal Fsel Distance from nearest well----S't�......Distance from foundation-----1_+:?____.___.Distance to nearest lot inAt e__s.�----------- Number of lines------------------------- - Length of each line--------34-------------Width of trench.------'- ----------------- ,t g f �t Type of filter material.cc_�5_.i_�__�__t_t-Depth of filter materiaL______.1__fS'___-,_,_Total length ---_- ----- Seepage Pi Distance to nearest welf_�1-DO--DO _.._--Distance from/�ffo�undation � ........Distance to nearest lot line__.___--____._ 6 Number of pits--_.____ ------------ Lining matersal-.c �- -Size: or 33 ----Depth.--.--�Zs-------------------- 10 1 Cesspool: Distance from nearest well-----------------Distance from foundation- _----------------_Lining material__,__....__------------------ els. S ❑ Size: Diameter--- `--------------------------------Depth-------------------------------------- -------------Liquid Capacity_----------------------••-9 Distance from nearest well-_.----------------------------------------------Distance from nearest building__---____________--__________---._.__._. Privy: _ ❑ Distance to nearest lot line--------------------------------------------------------------------- •----------------------------------------------------------- Remodeling and/or repairing (describe}:______- 4----..�.�'!_1r�_!__� -----•--& s-� ----------------------------------------------------------- ----------------------------•------------------------------------ -------------------------- ---------- ----------------------------------------------------------------------------------------------------- ---------------------------•------------------------------------------------------------------------------- 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. (Owner and/or Contractor) (Signed) - t� ?!71 .-�,.d----------- ^' ;--- ----------------------------- By:--: (rile) f. -- ---f� (Plot plan, showing size of lot, location of system in re tion to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY " . i rJ�------�-r-�- ------------- APPLICATION ACCEPTED BY ----- DATE / - -r ` ~— DATE--------------------------------------- ------------•------ REVIEWEDBY-------------------------------- -------: ---------- ------------------------ ----------------- i BUILDING PERMIT ISSUED------------------------- ------- --- ------- ------------ DATE:----- ------------ - -- Alterations and/or recommendations:__._ -��-- ---' _� _ .� --- -_ --------------- ----------------- "A r � •� y ------'-- — Q- �: . w a ---- -------- ---- sGLt_ � � " - ---------- -------- -- FINAL INSPECTION BY---- � Date----------------------- SAN - JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California ES 9 REVISED 8-59 3M 3-'63 F.P.r C. E