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FOR OFFICE USE: f ----- ------------------------ ] Permit No. --------------- SANITATION PERMIT ------------------------------------------------------- (Complete in Duplicate) - - --- � Date Issued - - ----------------------------- --------------- --------- This Permit Expires 1 Year From Date Issued F ----- 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. i JOB ADDRESS AND LOCATION-------------- M_�-5---------- Q `f` -------- LGT_fT'�D ��01��IC__.---CONN t�C}.t.-- Phone- Owner ne- ----_~_ Owner's Name-------- --- --- _ Address----------•1G'Z ia_----------1-1�i 13--�--D ----lk°l011��. T Phone----------••---------------------- ' Contractor's Name----�/}�Cr_1-�-------------•----•---------------------- - Other Installation will serve: Residence ❑ Apartment House ❑ CammerciaiTrailer Cour} Motel ❑ f ❑ !a Q[7t7_.-- ------i-------------- Number of living units: _---_ Number of bedrooms T.- Number of baths = -- Lot size .-----�-_..1 Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -- ft. PP Y� Y ❑ Y Adobe Hardpan ❑ Character of soil +o a depth of:3 feet: Sand ❑-"Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ ❑ .--FHA/VA: Yes ❑ No El New Construction: ❑ No [] Previous Application Made: (If yefL,date--------------- - I No (� • T�� , k -TYPE-OF-INSTALLATION-;AND-SPECIFICATIONS:-"� (No septic tank or cesspool I.permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--__.._---_-_--_Distance from foundation- __----.----_.Materia.--.____Ca Capacity FX1[nl-/n/G No. of compartments_ ------ -------- -Size-------------------------------Liquid depth i anc P Y r,� << Disposal Field: Distance from nearest well-_.S0 ...Distance from foundation__lj�-.........Distance to nearest lot line---- S of lines----------f Length of each line____-__-_---�7/ ------Width of trench___.-__ - -•---r--------- �� -- --------------------- - --------------------- --t- /l ID D Type of filter matenal__ Q-CK__---Depth of filter material----L7------ -----Total length________________ _ i Seepage Pit: Distance to nearest well--5---_ _-.----Distance from foundation----I _--------- tis n to nearest lot �__�--------------------- Seepage ---- i Number of pits_._-/- ___-- -----Lining material_RoC-�1---Size: Diameter- _----_-_ .. Depth- Li Cesspool: Distance fromi nearest well-----------------Distance from foundation_---_-_--_--__-- Lining material___- _-_----- --g gals. De th-- -------------Liquid Capacity------------------- g 171 -Size: Diameter------------------- P Distance from nearest w_ell------------------.------ -- ----------- -------- -Distance from nearest buil ing-.___--__._----.------------- -------- Privy: ,- � �'. ❑ Distance to nearest lot line---- --- --- ------- ------ ---=-----------..---------------------------- ------------------- ---------------------- Remodeling ------------ ------------------------ Distance -------- --------- -------- -------- i:1 _ l Remodeling and/or repairing (describe ---�-�-�-----I----�---•----=-----��-�--.��-.T_�_-.'-------------------- ----• ------------------------------- --------------- ---------------------------------------- `] d i I hereby certify that I have prepared this application and that the work will be done in:accordance with San Joaquin County uin Local Health District. ordinances, 'tate I ' and rules'a,' regulations of the San Joaq 3 - ___ .. _-.(Owner and/or Contractor (Signed]- -- _ i _ q - :-�--- - By:-.. -- -- -- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 r FOR DEPARTMENT USE ONLY E - --------- - DATE-- -=---1/----7.3-- -'l-- �-- ----------------- APPLICATION ACCEPTED BY r - ------------------------ DATE----------------------------- ------•---------------•------ REVIEWED BY------------------------------------- -------.---------- - --- ------ DATE------------------------------------------ - ---------- --- BUILDING PERMIT ISSUE ---------------- ------------------ ------------ ------------------ Alterations and/or recommendations-------------------------------- ------------ --------------------•--- --- -------- ------------ -i -_ -._- ---...----- - ----— ------------------------- --------- -------- i077 4/1 Date------------- !Y - ------414- ------------------------- FINAL INSPECTION-B-Y:.. -_ � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601'E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9111 Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.0 O.