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FOR OFFICE USE: -------------------------------------------------- _ APPLICATION AOR SANITATION PERMIT Permit No. _ ... {Complete-in Duplicate) - . --- -----=-------- Date Issued ______ _________ ____ ____----- j i 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. 1= t t I JOB ADDRESS AN LOCATION-... s--E'- -2,--- c _1_�_._ _ -!1_ ' l-Al------------ 5�_---S'-�----11Q�1'S � n L�l Owner's Name_l_-- > _ _1 ' Frl e�--------°`�Q_ L� --- --------- Phone__d-�'_3=~V i vo Address-----J -- --- .- - -- ----------------------------------------- --------- -----� -- ---- ---- Contractor's Name----:L.Y L.c_:. f " ---- Phone..- Installation will serve: Residence �;. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I-_- NR.umber of bedrooms _c7._ Number of baths_ __ Lot size ----- --- -------- -------- -------------------------------- . r� _ ft Water Supply: Public.system El Community'system [I Private � Depth to Water Table _ Character of soil to a depth of 3 feet'. Sand Gravel.❑ Sandy Loam D Clay Loam ❑ Clay ❑ Adobe[j Hardpan ❑ O Previous Application Made: (If yes,dote-------- --- --- ) No ❑ New Construction: Yes ❑ No E] FHA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel!-----6-0-_-_Distance from foundation-_--16---------Matgnal---dbJl10 ----------------- No. of compartments--------irZ_-__--....__Size_- .Y/%Y--1;:?-Liquid depth...67?SE.r•--- ------- Capacity_J-2- a--.--- Disposal Field: Distance from nearest well---6 ._.-Distance from foundation-_f O.-----.-.Distance to.nearestI ` line_-_-57-__-_- Number o0ines_-------------- Length of each line-----------7..6.._---------Width of trench.-_ ---._:._.____---__---.__ Type of fr.lter material-------- of filter material---- .--------Total length____.l`S-d-.__-_________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line......__=-------_ ❑ Number of pits--- ---- Lining material-------.......-------- Size: Diameter---------------.-------Depth---.----------------------------- - 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 to nearest lot line --------------- ------ --- --------•----------------------•----------------------------------------------------------------------- r I Remodeling and/or repairing (describe):-__-_ - --------------------- --------------------------------------=------ ------------------------- - ---•---------------------------------------- ------------------------- ---------------------------------------- ----------- - ------------------- ----------------------•-------------------- ------------------------ ---------------- ---------------=-------------------------------------------- -•-------------------------------- ------------------------------------------------------------- I hereby certify that I have 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. i (Signed)------C�t- ---- --- - - - -- ----------------------------------------------------•---- ---- -------(Owner and/or Contractor) �°----- -- --- ----- - Sy--------------------- - - - Title ---------- (Plot -------(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 APPLICATION ACCEPTED BY- - DATE--._7` 7 _ REVIEWED BY------------------------------------------------ ---------------- ----- ---- --------------------------- ------------------ DATE----------- -------•-•--------------------------------- I BUILDING PERMIT ISSUED-------- -------------------- -- -------.- DA-TE--------------------------- Alterations and/or recommendations:.---------- ----- ........... ------------ --`- ------------------------------------------------•-------------------------------------------------------- ----- -------------------•-------------- ---•--------------- --------------- -----------•-------;= - - ----------------------------------------- -•---------------------- -------- ------ - --- --- -------- - - - - ------------------ ----------------------- .................. --------------------- N BY•- Date.... - - ---FINAL INSPECTIOSAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 Wert Oak Street 124 Sycamore'Street 205 West 91h Street Stockton, California Lodi. California Manteca,California Tracy,California r — E.H,9 2M 1.67 Vorgucrd Press '