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FOR OFFICE USE: f ......... --- -- -- -45 s�..--_I----- -- --__-. APPLICATION FSR SANITATION PERMIT Permit No. _.411Z&.... ------------=•-------- -------------------------------- (Complete in Duplicate) ------------------------------------------------------------ This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND LOCATION------ 4- 77----o �q Owner's Name-------ZW------=r t?s `/C�c:_=_=- ==_ _ =- ----- Phone------------------------•----------- Address-•-------------A204------,e 11-X------• Contractor's Name ._`� ` ----------'S --------------------------------------- --------------------------------------------- Phone------------------------_------ Installation will serve: Residence RZ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units;.--/---- Number of bedrooms _J---- Number of baths _ .___ Lot size ....... x__L..' s�_.�---------------------- c Water Supply: Publie"system. .Community system_❑'.° Private ❑ Depth to Water Table -_____ ft. \�.J. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: ]If yes,dote---------------_ ---) No a, New Construction: Yes [?} No ❑ FHA/VA: Yes P�t- No 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---M -----__-Distance from foundation----f A-_r...... Material___eq_!!r4k!-_v_-A ------__--/� [g" No. of compartments_______ _________________Size �(_f S.�?�_/. `_Liquid depth----! '-.____-__-....__Capacity...9a a�rreL/ Disposal Field: Distance from nearest 'well---f14---...Distance from foundation_--- ......... Distance to nearest lot line--_,!---f_----_ [[3' Number of lines----------;1--___._•------------Length of each line__s�a_` _-Y.o !_..Width of trench------Z.! ..................____. .� Type of filter material--_1_ o_s_.Depth oftfilter material___f �`..._.____7otal length---.-_1.Z-�:`---------------------- T��— -r -.. ,�.R Seepage Pit: ' 01 Distance tonearest well----*9--_.__g__-_Distance-from foundation____/__°(___.___.Distance to nearest lot IinP-, .- -_._--_.- ` I �- Number of its----- = A----.Size: Diameter----3.3. _Linin material__-_1?q�-. Cesspool: Distance from nearest well.-------------___Distance from foundation------.-------------'Lining material-----------------------------.__-----. ❑ Size: Diameter---.----------------------- ----Depth----------------------------- ---------------------Liquid Capacity- --------------------._--gals. Privy: -__'Distance from nearest well------_------------------------------------------Distance from nearest building------__--_-------------______-.._-----. ❑ Distance ttz-nearest lot line. _=----------- ---- -------- ----- ` - E Remodeling and/or repairing {describe):-___._.-.-___-`--- # ------------------------------------------- - ---------------------------------------------------------------------------------- -- I hereby certify At l haye`prepa>red'this application'-and`that�fhe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations the San Joaquin Local Health District. (Signed) --------- - --- --- �-�I ---------------------------------(Owner and/or Contractor) fBy=--- ----- --------------- ----------------------------------------------------------------(Title)------------------- ...... ------------------- (Plot plan, showing size'of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY =—.GP��—L— -------------------------- DATE---------� --------- REVIEWED ---- J APPLICATION ACCEPTED BY_ . - REVIEWEDBY------------- ------- ------------------------ --------------- - ----------------------- DATE----- -------------------------------- -------------------- BUILDING PERMIT ISSUED-- `------- - ----------------------------- I------------------------ DATE-------------------------------------- - - Alterations and/or recommendations:_- '~_----- -_ � �• ~�~- -La e�-� 1— -----! _ /- "--- l ----------- ------------------------• -. /r ' FINAL INS OEC!ION ---------T T - Date.--------------------` SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California i'' Manteca, California Tracy, California k. F.RCC. i P