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FOR OFFICE USE: ------------ -- -I G� --- SJ- t: APPLICATION FOR `SANITATION PERMIT Permit No. . 1` •-- - _ ------------------------ (Complete in Duplicate) Date Issued _ _S1 .. `� ------- This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the rk herein d r d. This application is made in compliance with County Ordinance No. 549. n (�+ *� nn JOB ADDRESS AND LOCATION----- .. _! '-3 _'�-k 63�-- L[ Owner.'s,Name--------- :DAC c&-V_'-_-1"!_ — ------------ -=- -------------------- Phone----�_3_f----/ J 7 Address-------------•------- ' C.-- ------------------ -Ca-x ��.---------------------S-�c [�'( �[1----- ame2 ------� - -- ------------------------------------------------------- ------ Phone. ------••------------_ ---------- Contractor s N � � r Installation will serve: Residence 0 Apartment House [ICommercial ❑ Trailer Court ❑ Motel E] Other [I Number of living units: __}---- Number of bedrooms __.—rrNumber of baths _:� Lot size -------- Water _____Water 'Supply: Public system ❑ Community system ❑ Private M, Depth to Water Table ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 9 Clay ❑ Adobe ❑ Hardpan ❑ 3 No Previous Application Made: (If yes,date.--.___--_-- 1 No IV New Construction: Yes ❑ No FICA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 240 feet.) Septic Tank: Distance from nearest well __ Distance fr m�f7oundation___4-1-6-7-77'Matenal�. �-_.___-_________________ No. of compartments--------�-------- Size''A ,*--f-------=---Liquid depth -----------Capacity------?A�� q1r( I r p al Field: Distance"from nearest well- Distance from foundation-_-.____ ___-.-Distance to nearest lot line_______-_._.- g tr Dis os Number of lines_._I � ---------------Len th of each line--- of trench___ _�_____________________ I t Total len th'--------1610--l------------ ------ Type of filter material__- _[4EJqC'_Depfb of filter mate 9"E Seepage Pit: Distance to nearest well_____.______._"" Distance—, foundation__-___,___________.Distance to nearest lot line---------______- L' t -- ❑ Number of pits - Lining material «.__:Size: Di meter__. ---'------ -----Depth---------------------------- ,� I r. Cesspool: Distance from nearest well__-_________----Distance fr fo dation--------------------Lining material----____-------.-----------"""gals. Size: Diameter Depth----------- ----------------Liquid Capacity----------------------------g 4 ❑ r G 1 Privy: Distance from nearest well-_-__________--------_--------------------------Distance from nearest building-__.________-_______-------.------- -- ❑�n , ; -- Distance to nearest lot line------ f-- fey, �" 4 5 ------------ �/ Remodeling and/or repairing Idescri4�e}: N"- - -- .--- j _ 6 h -- �.3'_-�%_-------�' ------- - - --------- ( r ---- 1 -------------------- -- - - - I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin ounty. +, ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. (Signed) 4------------ --------- ----------------------------- (O ner and/or Contractor) ----- ----------- ------ -- ----------------------- Tttle ..... . -------- By---------------------------------------- ------- ----------------------------------- ( ) -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side}. I - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- --- -------------------------------------- DATE_.__-� -Y_�� --------- =- ---- -C �. REVIEWED BY------------------------------- ----------------------------------------------- ------------------------------- DATE BUILDING PERMIT. ISSUED----------------- ------------------------- ------------ - - -DATE Alterations and/or recommendations:------ ---------- --------------- - --------------------------------------------------------- --------- = _ ! - ------------------ -------------------------------- ------------- -------- I -------------------------- ------------ - - ------------------------------------------- ----------------------------------------I ------ --•----------------------- -- Date_DatQ ----------------------------- FINAL INSPECTION BY:.- `� �i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �r -1 F.F.CO. i