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FUiz UFFICE USE: p= 7---- ......... ..... ------------ ______________________ _____________________ APPLICATION FtbR-SANITATION PERMIT Permit No. _ _ - -- ------------------ --------------------- (Complete in Duplicate) --`-i --- This Permit Expires.1 Year From Date Issued Date Issued .F 71-`-:67 Application is hereby made'to the San Joaquin Local Health District for a permit to construct and install the work herein described. This as I- io is ma e n ion County Ordinance No. 549. lj� JOB'ADDRESS AND LOCAT TION -------- 4---... C Owner's Name--------;—/_vet --------/1/ Lfx_l '------------- -i ----- Phone ry _ -•-------- t 9 � ! ,°��-�`�------------------- �- ---------------•--------- --------------- Contractor's Name---— Phone 1p - u -------- Installation will serve: Residence 12"-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ l° Number of living units: _/_- Number of bedrooms�--- Number of bathsA--- Lot size _ .. t Water Supply: Public system ❑ Community system ❑ Private R�)1 epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ©''Hardpan ❑ Previous Application Made:. {!f yes,date-----------.--------) No Ej',New Construction: Yes [s]`'�!o ❑ FHA/VA: Yes 4?---No ❑ L TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance:from nearest well_-6:$7._'Distance from foundation__.l�_____.Mat��l_- - ------------- No. of compartments....�-------__-.__..Size_',�__C��____'#�JLiquid depth-_ �.-""- Ca acit lZ "" - P Y- ---- 4--- I Disposal Field: Distance:from nearest well__ __; _.__.Distance from foundation__t`�e_ :c_ "___._._.Distance to nearest lot line.47-- .Length of each line__�>~ _.___.f�____.Width of trench- r-'.--------- [Q Number;�of lines--- ,- -- - -x-------------- - ------------ Type of:filter mate ria -IF ,> Depth of filter material__A�"""---__--Total length__l- _ --------------------- Seepage ______ __________ :1 Seepage Pit: Distance':to nearest well_ /--Distance fLom foundation-'-ZI.:%—le Distance to nearest lot line Number;of pits--- ,-----------Lining material" 49 ..Size: Diameter_��-_ __.Deptnr * _ r � _ Cesspool: Distance from nearest well --------Distance from foundation .---.-_--------Lining material_______________________._ ❑ Size: Diameter-.'------------ -- ---"-- Dept '--------------------- Liquid Capacity---. ---------- gals. Privy: Distance'from nearest well__________________ ______________________________Distance from nearest building--------------------.-______._ -- ❑ Distance4o nearest lot line---------------------------- ? Remodeling and/or repairing)(describe):------ �------------ - ---- F/-_- , `•S✓ - ------ I I ------------------------------------------------ ---------- ------------- _ --------------------------------------------------------------- --------- '------- -------- I hereby certify that l have prd-rared this;applicatioh'and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules `and_regulations of theSan' Joaquin Local Health District. I / f� �- (Signed)----------- --------- -s°-=-��<-��'�� --�F-•- --' �-- -----�--�------------------------------------------OwneF_an jor Contractors (Title} By: ---------------- I./I � - ______-- (Plot plan, showing size of lot, location of system-irr/elation fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTEDi BY----------------- -- -- -------------------- ------ DATE------------- -�-�----��-- ------- ------- REVIEWED BY----------------------ti#`.' �.-, r -".- ;` - -- --------- '-- - ----------------- ----- DATE BUILDING PERMIT ISSUED ' DANE --------- - Alterations and/or recommendations:_(- Al- 7s.._-- -:-'�- -el ------------ -- I -----t /�'t-------- ---------------- - - --------------- ., - •-----------------------•-----------------------------------------------•------------------- i I = _:.. -.-------------------- --------------------------- ------------------ --------- FINAL INSPECTION BY:....Tz -- . - ,�- - g-4 ' - ----•- --- Date-- -------------�..°-�.�---------- - - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' y1601 E,•Na:etton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street i I! 'Stockton,California Lodi,Cahfoinia y Manteca.California Tracy,California F.P.CC.