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,FOR OFFICE USE: --------------------------------------- FOR SANITATION PERMIT Permit No. .-../ �° . ------------- --__-------- ---------- ------------- ........... .... (Complete in Duplicate) Date Issued _.--- -------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ' P L7% !" .w QLD "` r `JOB ADDRESS AND LOCATION__OM-- d f----5' .C� ---- !—— _'rp----------------------1 ✓��----------'Z--"----�----��7G�- Owner's Namer --- ---------------------------=------ Phone_�< f IIL- !._h_ _ f - - �r ------------------------------------------------------------------------ Address__________________ _ .,` -lS ) ):_1 ��-' ------- ------------------------------ ----- Contractor's Name.-------- Installation will serve: Residence ty Apartment.House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _A.____ Number of bedrooms ----I_ Number of.baths --I----- Lot size ___FAD__.'------x----l_00_------------------------- ,. Water Supply: Public system 171Community system ❑ Private ❑ Depth to Water Table 1Q_ ft. E Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam � Clay E] Adobe [3 Hardpan ❑ Previous Application Made: (If yes,date----_ ----_" ) No.K New`Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: __--4•(No septic tank of eesspbol perirnitted if public sewer is available-within 200-feet:) "'`" ...... �. Septic Tank: Distance from nearest well__NnA_e__Distance from foundation-----1.0_______- ya-__ - ___�_G� __r � _Mat _______________ e �-. Capacity--- No. of compartments-------- --__Liquid depth i --._____-__ ------- 1 � Disposal Field: Distance from nearest well__i1 014 Q"_Distance from foundation-__=�_O'- ____.Distance to nearest lot line---------9-------- U.1,ca Number of lines-------------:?_________________f Length of each line------2 o-'________1-----Width of trench---------- __4 V____________ V Type - p ----------- T e of filter material__ _.[fir lam.-�De th of filter material____"__)__ Total length_____________ 9P! Seepage Pit: Distance to nearest well------ -------------- Distance from foundation--------t t--__._,Distance to nearest lot line----------------- F1 - Number of pits------- -----------I Lining materia.l------------------------Size: Diameter------------------ Depth- ------------------------------- � i I i t Cess ool: Distance from nearest well________________Distance from foundation.--_-.---.____-__.Lining material___--------"____________- 0 p f -------:-Depth----- I--------------------------- ------- Liquid Capacity---- -------------------gals. ❑ Size: Diameter------__________ -- LL _ - _ -� -� --` -- -`_ Distance fro ecresf buiiclin `._"'�-- Privy: Distance.from nearest well g ❑ Distance to nearest lot line----------------- F '------------- ------------------------ --------------"------------- ------- ------------------------ ` 1h_Remodeling and/or repairing (describe):----��- �-5"�.-f'[1.:�L..---=---�-�-`-�-`�----------��--�-`��"-�-- - --'--------------------- ------------------------------------ 1 f --------- /------R- ----- - ----------•-- - --------------- ------------------- -------"--------------------------- -------- == her - have ----------/------------------------------------------------- --------------•.." - - I hby certify that I prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- '= '' 1 --------------------------------- -------------------------------------------- and/or Contractor) - By:_ _.._= C � �- ---- ------ ix _ _ Title • ------------ ( ) �. ... —. _ .._--.- _ (Plot plane showing size of lot, location of sys min relation to wells, buildings, etc.,'can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- -- ------------------------------- DATE----------------------- ----_-----------• ----------------- -- ------------------------------ REVIEWEDBY-------------------------------------------- -- - -------------------- --------------------------------------------------- DATE------------------------------------------------------ ..� BUILDING PERMIT ISSUED------- -------------- DSAT ` t� ------ Alterations and/or recommendations:..___ :� --- E --`��''.f�•�r1-`G-�--•L�F.h�1�sc---� .-�`1'`----'ilk-�.i.---�1.�71i_- �i t ---- - - - - � �f ------ ---- --`r]--- � .� c� i._-�_:.'_{' �_._ -- .-[- .'Wf'L�`$[,�[�•f�'1'C. J/1..�, � - �i "' �' -f'�/ ��f11 -.!�(�J�tir F.rt�� "�-�� nZfl_{ti7-,� �. - - Date__..._l ._"^'- rz ."` ',;"� --------------------- FINAL IN SP TION BY:.. N''�OCAL HEALTH1 ZISR C� 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocklon,California Lodi,California Manteca,California Tracy,California 10 9 REVISED l3-59 31A 3-'S9X-1 . .CC. r � �� ! � f� ./�� jJ �• ��'1`1 "(a4) �^" L