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FOR OFFICE USE: -1=0R SANITATION PERMIT Permit No. ---I----�- ' �_ --- -- APPLICATION �licate Date Issued ---/[---r(Complete in Duplicate) / -�----r�-••-- ---- ------ --------------------------------------- This Permit Ex fres 1 Year From Date Issued App lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe c This application is made in compliance with County Ordinance No. 549. i 1 4 --•------------ JOB ADDRESS LOCATION----- -Q4-- Phone - = Owner's Name_ _.. - Address C2_19... dT - -- ---- _ .�l � Ph ��= Contractor's Name__ ___ _________ _ _______ ___ Installation will serve: Residence [ apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Lot size ---��r-•�--•----- -- ----------- Number of ---- ----- Numberof living units: _ .___ Number of bedrooms ----- Number of baths I---- Private ❑ Depth to Water Table 69 ft. Water Supply: Public system ommunity system ❑ Adobe dpan ❑ Character soil to a depth of 3 feet: Sand F1Gravel El Sandy Loam �] Clay Loam [3 Clay ❑ Har , r Previous Application Made: (I# yes,date.. No FHA/VA: Yes E] No [I_.._-_---.------1 No ❑ New-Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is �ailable within 240 feet.) 1 1c Taikc Distance from nearest welL________________Distance from foundation_____".`.__-_------lvlaterial--..._____--._____-------------•----------------- 1c ---- ' Q� , • � F Liquid de th--------------------------Capacity------ ------------- 0 , s"'� No. of compartments-------•------------------Size__.--=-----------�- ---------- q p• Q I Q-�.--.Distance to nearest lot line__' �p osal Feld: Distance from nearest well,- _�7c4/_Distance from foundation___-F Width'of trench-.�...Vfs-=-------- b --- Len th of each line___ =---------------- Number of lines--------j- - -- --- ---- g Type of filter materials Depth of filter material___ _._ Total length_______'".___ __ __ ' # . i t r 4 Seepage Pit: Distance to nearest well _4 Distance rom foundation_ _. .......Distance to nearest lot line___. Number of "pits-------- --- ----Lining material " -13- - .Size: Diameter___--_,�,3_! .Depth__.__ - Cesspoo Distance from nearest -----------------Distance from foundation -________.__'__.Lining matenal-_.___________________`________._-. Size: B"iometer. --------Depth------------1---------------- --f----:------------ Liquid Capacity.... gals. ❑ _ _` --Distance from nearest building ---- -------- 1 Distance from nearest well------------------------ = g - Privy: ---- ------------- ------------ ----------------- I �i__ Bistance to nearest lot line_____________________ l �` . � � � Remodeling and/or repairing (describe]________________ _ �� ,� ----------------- --------- _ --- •- ---p ( f- i"=' ----- ------------------------- - ----------------------- ---------• ------------------------------------------ I ----------------- ---------------------I hereby cert'f that I have prepared this application and that the work will be done in accordance w with San Joaquin County , ordinances, S s, d rules a d regulations of the San Joa ocal"Health District.�'"" 1�' \ t -------------- (Signed) r Contractor] ----------- (� (Signed)- ------- -------------� - ------------ -_: - -----(Title) - - BY=--.------------------------- can plan, showing''size of lot, location of.system in relation o wells, buildings, tccan be placed on reverseside). �F- �' FOR DEPARTMENT USE ONLY T f''�� APPLICATION ACCEPTED BY " ---------------------- ----- DATE /[.%a__f �J - DATE------------------------------------------------------------ REVIEWED BY--------------------------------------------------------- DATE------------------ --- ------ - --- ---- ------------------ BUILDING PERMIT ISSUED----------------------------- -------- r---------- ---- . Alterations and/or recommendations:._-___. __. ----- - ---- f` Y-, ---------------------------------------------------------------- ------------------------------------------- ------------ -7 i ---------- -;------------ ---------•------- ------------------------------------------------- ----• --------------------------- Date --- --- �-- FINAL INSPECTION BY:.....`�..:1----------- -------------- _ d ----- fSAN LOCAL HEALTH iDISTRICT _ �,. � . . 1601 E.Haxellon Ave. 00 West Oak Street 124 Sycamore Street _71 205 West 9th Street Stockton,California . Lodi,California Manteca,California Tracy,California CS 9 REVISED B-59 3M 3-'63 F-V.CC.