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A. APPLICA TION FOR SANITATION D� N AERMIT Per i (Complete in Duplicate) mit No. _l This Perini# Ex ires Z Year From Date Issued p+ppf;cation`is hereby - Date Issued y made to the San Joaquin in Local Health District for a permit to c This application is made in compliance w;fh County Ordinance No. 549; -n onstruct and in the work herein described, t JOB ADDRESS A .O S` Owner N r s Name_"___- - -- f Address �` -- �2_ --- > tT !. .._ �.._.,. w Contractor' ---. - - - Phone----s Name_ ------ --------- ----- fnstallat;on will serve: Residence ------- Apartment Ho , -------------------•----------- ❑ A �� ._ice -- - - -_ ----- ------------------------------------------------- ---•--- Phone / use Commercial - �'' �-_---_ ' Number of living units: -_ r �`" -• .--__ Number hof bedrooms"__- ❑ Trail f��. Motel Water Supply:: -- Number of Baths __'-� ❑ Othert ff V� Pp y Public system E ' t - Lot size _-- r I� Community system El Private �� y - •- Characier of soil to a depth of 3 fee#: Sand . �r.. ❑ Depth f6-,Water Table S` ! ❑ Gravel r i'• Previous Application Made: Yes e❑ Sandy Loam ❑ Clay Loam ❑ No"! f New Construction. Yes ❑ Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �,� O / A: ❑ FHA -V Yes ❑ No ❑ (No septic tank or cesspool permitted if public sewer is available within Septic T k- Distance from nearest well _ 700 feet.) / (a e NO, of compartments_._-_ Distance from foundation._ ----- Size Material Disposal -field: ,�p Distance from nearest wellQ '`-LiquicJe th__-__--S_ - - -- ----Distance from founda ions` __ Capacity./ Number of lines_____�_g _J__ ___ � T Length of each fine_-- Q-� Q.........Widtcoftfre ch. to ins- ------------ ype of filter material__, _r _ Seepage Pit: --------- Distance to nearest well------ Depth of filter material -__ .__ f � ---- -----Tota! length-----��--------- ❑ ---------------Distance from foundation_-_._ I Number of pits--------'-"--_-- --------•"""- • ----------Lining material___-_--_ Distance to nearest lot line_______________ Cesspool: ---------------Size: Diameie -------: Distance from nearest well_ ____________ Distance from foundation.._.-_--_- Depth____"._--_---- Size: Diameter-_-- -._-_ � I .---_.___.Dining materia!"-___-_- --- I--------------------Depth--------- Priv ---------------------------- Y:, Distance from nearest`'wefl-1_---_-- ---------- ---------------- ---------Liquid Capacity------------------------_ ❑ Distance to nearest lot line__-__--_____ _ "-__- --"- _- _----_ Distance from nearest buildin gals e Remodeling and/or repairing describe)_--------_______--_" - -----------_ --------------- ---------------- ----------------- --------------------------------------------------------------------------------------------------------- --------------------------------------•---------- 1 herebf tI that ! h prepared this application and Thai the work will be done in accordance wiordinances, la , and r s and re ulations o the San Joaquin Local Health District. #h San Joaquin County (Signed)_ - - By: - wrier and/or Contractor)-- -----•--•------------------------ --- A4 {) , (O ; (Plot pian, showing size of lot, location of system in relation to lls, buildings, efc., can be placed on r-- - - ----everse s-------- id ----------- Title) FOR DEPARTMENT USE ONLY t' APPLICATION ACCEPTEDBY_.._"___-____ REVIEWEDBY---------------------- ------------------------------------------------------------- oATE BUILDING PERMIT ISSUED DATE f (_ -J ---------------------------------------------------- -•- ------ Alterations and/or recommendations:--"--_".-_-___.-__ - ----"-`- " --------- -----•------ ----- DATE--- ------�---------- --- , --- -------- -------- ----------------- --------------------------- I- ------------------ ----------------------- ----------------------------------------------- --------- ?•--------------- -- ------------- ----------------------- ------------------------------- I--- ----------------------- ----- ---------------------------------- ------------------------------ ----------------------- --- ------I ' -------------------------------------------------------------------------------------- ------------------------- �:------ ------ --- --- ------------ -------------- --------------------------- -------------;. ----------------------------- ------------I-------------------------------------- ----------------------- ------------- -- ---- ---------- FINAL lNSPECTIO - -------------------------------- /4 ..-�- - -- ---- -------- SAN.JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300-West Oak Street 132 Sycamore Street Stockton, California Lodi, California 814 North "C" Street Manteca, California Tracy, California 1