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r FOR OFFICE U1 tE - --------- ; -------- --- 'F ..a.� [ r Permit No. S_- - _-- APPLICATION FOR;_SANITATION PERMIT # i ------------------ ----'- _._... --------- - ------------------ - - (Complete-in Duplicate) ,�, � Date,.Issued This Permit Expires 1 Year From Date Issued` 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work it rein�des�ribed. This application is made in compliance with County Ordinance No. 54.9. � �..�.[ �. Il Zo`7 ' /]�,� y�J. �rL. .�-..._..!I F-1-..../(e -- •-------_-�_ -----'- JOB ADDRESS AND LOCATION... - '" Owner's Name---- --- ° . - - - - - -- ------- - --------- ------- _ Contraor`s Name� :__.:� -- -----1 d� t �'�4°• P one_ ____ ct Installation will serve: Residence partment House E] Commercial C] Trailer Court ElMotel El Other El f �y Number of living units: -/__ Number of bedrooms -�1. Number of baths.-..__-- Lot size ..... __ .--1=-- -- -- --- � 1 Water Supply: Public system ❑ Community system ❑Private ° Depth to Water Table _ ft r Character of soil to a depth of 3 feet. Sand E] Gravel'❑ SandyCoam ❑" Clay Loam [I 'Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_.----------- ..__ I No j -New Construction: Yes No E] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: e. N . septic tank or cesspool permitted if public se within 200 feet.),- .---,.(No / f _ Septic Tank: Distance from nearest well_,6 - -f_Distance from fou'ndation___,r._a._____._.Materi�_`.. "`G ----- j No. of compartments-.'--------a _-_..- Size�ax X4-_-Liquid depth--- --c..... --:_ .Capacity��2Lt_o_ ,r •C t ; ,1Q-_------Distance to;nearest lot line_---�r------ pisposal Field: Distance from nearest well--- _---Distance from foundation__ -_._` _ ��, Number of lines --.'--- Length of each lane_:' ,-- - - �� Total h of•;trench-_-- _Cid-----------------•-- Type of filter material_ filter maternal..` __.e length---..-. zQ ------------------ of --- Q Seepage Pit: Distance to nearest well_ QCT._._ Distance fr m foJndation_ �_:______Dista to nearest lot line._? ..... _ __. Number of .pits.- ------- -- t De th Lining material--/_ Size: DiameteJ_��-.._._.. . p e�- ---- i -- Cesspool: Distance from nearest well ................Distancce-'from foundation._...-!--..___.. ..Lining material----- Cesspool: Size: Diameter- - --------- -- - ------ --- Depth------------------------=-------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest welL...............'�_.-----___----- --- --....-Distance from nearest building.___._-.___--__...___________. ..__._. .! 'L j ❑ Distance to nearest lot line -�- -- --------------------- ; f •� 1 .� .� .r.wA.o. . .� ,.i R � -- Remodeling and/or°repairing (describe]:_.._..-..--'----- ------------'--------- •--------------------- ! ` .T --- -------- ------- ------------------------------------ ------ 1 «. ----------------------------I-- ------------------------------------------- ------------------ _ ---- ----- --------- t ___.._....,-------------q4_._____ ------- -------- ------------------------------------------------------ ------------------------------------------------------------------------------- -------------- e I hereby certify rthat,l 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. s ' ....... -- --- --- ---- - • ---- --- ------------ (Signed) - Owner and/or Contractor 'jl . ..- - �. - --, ---_.------ 1 ------------- ----�-(-Tit s (Plot plan, showing size of lot, I cation of system in relation to we11s,'buildings, etc.,,can be pl don reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .' . - -- -------------------------------------- DATE._._ _-. _7...'. - REVIEWEDBY- =----------------- -------------------- ----- -- ------------ ------------------- DATE - a-. DATE----- ----------- ------------------------------------------ l BUILDING PERMIT ISSUED - - Alterations and/or recommendations:_. ------------- •---- ------------------------- ----------------------------- --- --- ----------------------- I - - ------------------------------------------- ----------- ---- -------- - a11' - ------ ---- -----• ------------ ---------- --- • - ----------- -------------- ------------------ - ----------------- ------ --------- --------- aDate../�__0 .70L---- -------- --------------------- FINAL INSPECTION - L_ %SAN JOAQUIN LOCAL,HEALTH.DISTRICT Jr, 4 1601 E.Hatelton Ave. 300 West oak Street 124 Sycamore Street 20.5 West 9Th Street 1 5lockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press '