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i. F7 OFF CE USE.' IC _ ----------------/__� ----------- ------------- ------------------------------- APPLICATrON I=OR SANITATION PERMIT Permit No. -t 7 ' ----------------- - --------------------------------- (Complete in Duplicate) - ------------------I--------------------------------------- This Permit Expires 1 Year From Date Issued Date1ssued i12A 4K Application is hereby made to the San Joaquin Local Health District for.a permit to construct uct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.';-t---------- ------------------- -------------------------*------------ ---------------* ------------------------ Owner's Ham e------------ e................ q 7 6oe- 9.27 Address - --- ----------------------------------------------------------------------------------------------*---- --------*--------- ---------------------------- 11 hl ------------- - -- ------------------ ne--- ------ Contractor's Name____ ------------------ Pho Installation will serve; ,Residence Apartment House 171 Commercial [3 Trailer Court [] Motel [] Other E] Number of living units: --I----.,Number of bedroomS _'5--- Number of baths Lot size ------- ------------------------------- Water Supply. Public`system E❑ I] Community system L] Private 19 Depth to Water Table 4'0 ft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam El Clay Loam [D Clay K Adobe❑ Hardpan El Previous Application Made: (If yes,-date-------------------2) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_______.__`__Distance from foundation------------------- Material----------------------------------------------- El No. of compartments-------------------- ----Size------------------------- -----.Liquid depth---------- ---------------Capacity------------------------ Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distan6e to nearest lot line_____:_-_______ El ) Number of lines----------------------------- - --Length of each line------------------------------Width of trench-------------------_-----------:.- 1�y - - material-_---------------------Total - 0 Type.of.filter,material---------•----------------Depth of filter length----------------------------------------- Seepage Pit: Distance to nearest well-_,050-0 -------Distance from founclation--1/on-1......Distance to nearest lot line....... Number of pifs.,:----/-------------Lining material -.A-e.-cv,/<.Size:'Diamefer Depth-------- j__._ Cesspool: ----Cesspool: Di.-stance .from nearest well_________________Distance- 'from foundation-_-__.___- -__-_-__lining material____.____________________._________ 0 Size: Diameter---------I-----------------------------Depth_--------------------------------------------------Liquid Capac ify----------------------------gals.- Privy: .Distance from nearest well---------------------------------- -"- -_________Distance from nearest building-:-------------------❑ ---------------------- A3 Distanceto nearest lot line-------------------------------------- ------------------------------ -------------- ------------ ------------ - -------------------- Remodeling and/or repairing (clescite):-------- �--- I. e� 21 _ - -- --- ---- ---- ------- ----------------•--------------- -------------------------------------- --------------------------------------------------------------------7---------------------------------------------------- -------------------------------- go' ------------------------------------I------------------------------------------------------------------------------------ ----------------------------------------------------•--------------------=----------------- ----------------------------•--------------- ------------ --------------------------------------------------- ----=------.---------------------=----------------------- I -----------------------M_-----------------------------I hereby certify that) have prepared this application and that the work will be done in accordance with Sani "Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Loial Health District. ....................... (Signed ------L,--- ------------------------ -----------------------------------t_.___'__-_(0 ner 'and/or Contractor) By:----------- ----------r------------------------------------(Title)----- - - --- -- ------- ......................... (Plot plan, showing size of lot location.of system in,relafion to wells,.buildings: etc'., can be placed on reverse side). FOR DEPARTMENT USE ONLY' APPLICATION ACCEPTED BY-------- ------i----------- DATE------ ---- ----- -------7-1 ----- --------------- REVIEWEDBY------------`---------------------- - ------------ -- ---------I--------------------------------------------- DATE------ BUILDING PERMIT ISSUED- , ---- -------------- ------- -------------------------------------------------I---------------r---- I DATE---,---------- ------- ----- -- -- ------------------ ----------- '77 Alterations and/or recommendationii.--:"-�.-, 7-e/,.(-.'.--7—--------r---------- —---------- --------------- ----------------- -----------(_r ` ------------------------------------------------------------------ --------------------------- I I , .1 1 -------------------------------------------------------I----------I--------- ----------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ---------------------------- ------------- --- -------:----------------------------------- --------t.... ---------------------------------------------- -----------------r------------------ - ---------------- ----------------- ----------------------------------------------------------------------------------------------------------------------- ------------------- ----------- -------------------- FINAL INSPECTION BY:..... ....... -- ---- Date-------- ------- ---rANJOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California:, f Lodi,California Manteca,California Tracy,California CS 9 RrVISED 8.59 MM 3`6:) F.F.00.