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FOR OFFICE USE: y F ............ .. ------ -_ _____----- ------------- APPLICATION FOR SANITATION PERMIT Permit No. _-iLe-gff --------!tA---------------------- ---------- ------- (Complete-in Duplicate) Date Issued .-.S. -"4 - - ---- .-.. This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. � i JOB ADDRESS AN LOCATION_-•- b-7-7} ��- ' ��1 '✓Il ( = - SCgL-QIV Owner's Name------V-!-C-70—M_fo --r �.l Phone------------------------------------ Address-------A-7.7� ---------S----------------- ji9_-W.R.E - . C Contractor's Name__4.jk.W;FR,__ r --- -. -----. Phone------ ---------------------------- -------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑' Motel ❑ Other ❑ Number of living units: _.I.;.- Number of bedrooms ...1.... Number of baths._L.... Lot size /5_1 000....a-r--__1-`---------------- Water Supply: Public system ❑ Community system ❑ Private epto Water Table7. _.ft Character of soil to a depth of 3 feet Sand ❑ Gravel p Sa y Loam p Clay Loam . `Clay ❑ dobe ❑ Hardpan Previous Application Made: (If yes,date___________________ ) No New Construction: Yes-❑ h!o FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic -e� Distance from nearest well...- ---_Distance from foundation......f2-------Material _CQf� Rlsa ............. No. of compartments..__..---Z. __......Size._. 'x_57_Liquid delath.....-y�_./Z.___ Capacity._--_��d-�.-... Dispos ;eld: Distance from nearest well.-$70__...Distance from foundation-.-..f ........Distance to nearest lot line.._...._... \ Number of lines ----------V------- ------------Length of each line-. ..5.... ...r Width of trench.____- <<-_f— Type of filter material Depth of filter material-.-----1- . Total length-------_.___.----7r' .. .-..... Seepage t: Distance to nearest well_ ----___Distance from foundation-----/V----------Distance'to nearest lot line-.... Number of pits... .-_ ----------- Lining material...._�- CK. Size: Diameter. -��---------Depto / 2----E- --------- ---_ . Cesspool: Distance from nearest well ................Distance from foundation_...__........... _ Lining material----------.-------------------------- ❑ Size: Diameter- -- --------- ----- ----------------Depth---------; -- . Li uid Capacity .-- --_---------- -- ---------- q ----------------------------gals. ._« 4.�� Privy: Distance from nearest well.-.-.............................s_._.__-_--_, _D.istanae-from_nearest building-------.-------------------------------_- El Distance to nearest lot line - ------------ ---------------------------------------------------- Remodeling and/or repairing (describe)-------------------------------=-----'=- ------•-----------------•-------------------- - tr r ------------------------------------------------ ----------------------------------------------------- --------------------------------- --------------------------------------------------------- =----•----------------------------------•------------------------------------------•- -------------------------------- -- ---------- ----------- ----------------------------------------------------•--------------------------------------------------------- ------------=------------------------------------------ --------------------------- I hereby certify that I have prepared this application and 4haethe work will be done in accordance with San Joaquin County ordinances, State laws, and ules and regulations of the-:San ,Joaquin-Local Healtl7Aistrict• (Signed)__- - ------ - ----- _ --..-..-.' ------_ ----,-- --- - ,- ------ -----{Owner and/or Contractor) BY=-------- ----------------------------------- --- ------------------------ --------- - ---- ------------------------------. ---.-(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 '-`APPL [� REV KATION ACCEPTED BY -T-43--a------- --- -- ------------------------------------------------------ DATE--------f;` 3 Q = --------------------------- WEDBY ----------- ----------------------------------------------------- -------------------------- DATE----------------- BUILDING PERMIT ISSUED-------- -- ------ --------------------------------------------------------------- ----------------- DA-TE------------= - Alterations and/or recommendations-------- ------------------------------------- -------- ------------------------- ----------- --------------------- - - -- -------- ---- �. ---- FINAL INSPECT! �. -p- Date_........... ------- SAN -----SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5locklon,California Lodi. California Manteca,California Tracy, California E.H.9 2M 1-67 Vanguard Press f