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FOR OFFICE USE: IF --------- ---------------------------------------- APPLICATION FOR�SANITATION PERMIT Permit No. . l�.s ---------- ---------------- ------------- --------------- (Complete in Duplicate) - -- ----------- This Permit Expires I Year From Date Issued Date Issued _3_--3_a_-47 -2 7� /'lfa—f 6 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei described. This application_is made.in comp[ianc with County Ordinance No. 549. ►,_I'j f v {: • :Mira_ -+��. . i JOB ADDRESS AND LOCATi S A4;�---A1 ---- --10 AA, Owner's Name--------------- s _ ----------------- Phone------------------------ Address----------------- T_ _` � -------f 5 7--------- ----------------------------------------------------------------- Contractor's Name-------2%J fJ.E� K --------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �, Number of living units: Number of bedrooms _7).- Number of baths ________ Lot size __.�}_C-� - 14 Water Supply: Public system ❑ Community y system E] Private Depth to Water Table��____ ft. I CR Character of soil to a depth of 3 feet: ane�eGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ '"� Previous Application Made: (If yes,date......... -------_J No New Construction: Yes R� o ❑ FMA/VA: Yes fff-'No d TYPE OF INSTALLATION AND SPECIFICATIONS:. (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__6��,_.___Distance from foundation--j.6__.____--Material_�/��'RE_T~�:- -----_ __Liquid depth---��-----Capacity_-- -- n No. of compartments__.. ----------------S:xe_ J�_ l° _ ---- / Disposal Field.: Distance from nearest well._._' ------Distance from foundation----/49 ---------Distance to nearest lot line_-:�..__...... .� Number of fines------ _- — ---------------Length of each line------% ___r_____-_ ----.Width of trench--------�41 Type or filter material___ . _Q_CJ<_ __Depth of filter material____.f__C/--r` Total length -----------�s��--�'-----�-- -_-_-_-_--_-- 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--.---------------------------------- 0 Size: Diameter------------------ ------------------ Depth----------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well----------------._.------- -------------------- - from nearest building ❑ Distance to nearest lot line--------- ------------------------------------ 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 Ila , and rule` and�gulati6ns of the San Joaquin Local Health District. E (Signed) ------.---,------ : �'f ../tom —. ---------------------- y _ (Owner and/or Contractor) Y:--------------------- ----------------- •-------•--------- - -- - ---------------- ------------------- -- ----------------------(Tit(e)---------------- ----------- --- ----- - -....- --- -- (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 F APPLICATION ACCEPTED BY------ A---------------I------ ------------------------------------------------ DATE----- ---------------- REVIEWED BY---------------------------=------------- ------------------------------------------ ------------------------------------------- DATE-------------------------------------------- ------- .. ------ ---------- -- --------------- BUILDING PERMIT ISSUED-------------------- - ---------------------------------------------- DATE--- ----------------------------- --------------------------------- -------------------------- A terations and/or recommendations--------------- ------------------- •------------------------------------------ --------------------- ------ --------------- ---- ----------------------------------------------------------------•--------------•-------•--------------------------------------- ---------------------------------I--------------- ----------------- -- - - -- ----------------------- -- - - - ----------- -------- ------- ------------------ ---------------- -------------------- FINAL INSPECTION B - _-- -_--- Date----------- ----- `-_---_..-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 309 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.0 O. m �•��