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FOR OFFICE USE: ` --------------------------- t _ APPLICATION FOIA. SANITATION PERMIT Permit No. _- l Z ------------- -- ---------- - --- ----------- ------- (Complete-in Duplicate) This Permit Expires 1 Year From Date Issued bate issued u t 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. 1-11 JOB ADDRESS AND LOCATb jN/D OO D �. /��' ---- ------------ -------------------------------- --``----------------- -------- ' Owner's Name--- --- -- ---------- -------- ------ ----------------------------- ----------------- Phone- -fF-.. (-��-`--- - -----------------•-•-------- Address----•-•--------- - - - - -�-��gg--�-----..-- -----•'-r,/--�---------•- -�- -------- -------------------------------------- ---------- - -- Contractor's Name_... .. Gam- -------- Phone Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r . � r W ter Supply: f living stem'` Z _Number of bedrooms _J_ Number of baths -�Lot size -`Q` -_�------I---7-r------------------ a pp y. y j❑ Community system ❑ Private Depth to Water Table 10 ft 0 Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loamk Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Q Previous Application Made: (If yes,date-------- J No Qf New Construction: Yes No E] FHA/VA: Yes El No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: / `` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f yy UP,< r e Septic Tank: Distance from nearest well---�.Q-_____Distance fr�jm foundation-f�r_�--------Material -"�.-._-.-.-_�.-" ________ ( No. of compartments-.- Size-----1----A-9 0--------Liquid depth--------- -- ---- --------Capacity/,a.�-P--Q------ Dispos I Field: Distance from nearest well.. .--._-.-.-Distance from foundation--- . C-)__ .Distance to nearest lot/line_--6._-"-..... ' Number of lines------ ---0-------------------_Length of each line-- --./0-Q...s..--....Width of trench---A-------- ---------------- ✓ 1 Type of filter material._--.94Z/E�_--Depth of filter material----- ________-..Total length-----... -Q-------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----.-------.... 1❑ Number of pts--- -----------------Lining materiai---------------------- Size: Diameter----------------------Depth--------------------------------- Cess❑ool: Size Diameter.nearest well ......:.........Dbes�pth--e from foundation . --------------.Liiquild Capacity- _.-.---.------.-----_-_gals. p Privy: Distance from nearest well-------------------------- ----------------------Distance from nearest building-------____-------.---------..-------.-.-. ❑ Distance to nearest lot line------- --------------------------------------- -------------------------------•-------------------------- --------------------------- Remodeling -------------------------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 rule;'requlafiods of the San Joaquin Local Health District. ? -----------..............._------..-. Owner and/or Contracto7 +---a,tr' [Signed--------------- - -- ----------------------- --- - ----- --=---- - -.......--------- --- - - { By---- ------ -------------------------------------------------- --- ----------------- ---- -------------------------- -------------(Title)----------------- ---------- - ------ - (Plot plan, A ng size of lot; location of system in relation to wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY 77/ DATE_ACCEPTED BY . b;_ _7 --------------- REVIEWED ---- BY------------------------' ---------- -.-.------------------------------------------------------ DATE----- ------------------------------------------------------ BUILDINGPERMIT ISSUED--- ---- -- ------ ----------------------- ----------------------------------------------- ------ DATE---------------------------- - ----- ------- - --------- --- Alterations and/or recommendations------------------ --------- -- ------------------------ -------------- -----------------------------"-----------------"--------....- ----------L-------------------------------------------- - ----------------. ------------------------------------------------ - ------------------•--------------------------- ••------------------- -------------------- ------------------- -- - .--- ---------------- --- -- ----- FINAL INSPECTIONT SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press