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` FOR OFFICEFUSE: .r ION 1=0R SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued -------------------"-------------- ----- ----.-.--_ This Permit Expires 1 Year From Date Issued -2D� -- Sd -1 ?� ------- ------ I[ Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta the work rein described, This ap lication is made incompliance with County Ordinance No. 549. (L2'3 S:�rc► 5 - . ---- -- JOB ADDRESS AND LO ATI �� - -- - --� --•----- - "�- v Phone------------------------------- Owner's Name____ _____ - ---------- ----=-•=------------••- t ---•-- - --.---. ----------•-------------------• Address----.. - ----------- ------- --- --------------- Phone-------••------•-----------------•- Contractor's Name... --- - - -- - ------- ------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._ Number of bedroo J.- ms „ -.. Number of baths "- Lot size -------- Water Supply: Public system ❑ Community system ❑ Private 2rDepth to Water Table A?_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam IV Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.- ........;--------) No New Construction: Yes ❑ No FHA/VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: ( p �p Ppub ,. hin.200-feet.].._ ._ Septic aokse tic tank or delf lic-se-Distanceafrom foundation____. Material----------------------- SeP v x ' - Li uid de th------------------------- ion =a - Capacity-------R--------------- P.'�jlp No. of�compartments_ Size----------------------------- • - l� q ------- Distance to nearest;lot line___ft�_-----. Disposai Field: Distance from nearest well... 'Distance from foundation__. r �' Number'of lines_____'" ___ _-Length of each line �'�� ,�-Q".Width of trench..- ""-"--.-------- , ., �y ' !/ ' aDe th-of-filter-material---'-- ": r__:Total-length__._-------"-- Q Type of filter mafier�al_ -- p ' ,_ Seepage Pit: Distance to nearest well_____._____.____---Distance from foundation____________________Distance to nearest lot line-----.______-___ ❑ Number of pits--------= Lining material-----------------------Size: Diameter Depth - F tn � t - ._" Cesspool: Distance from nearest well________---"'___Dstancerom ls. Dm ----- Liquid CaPacty------------------- ------- t 9j Size: aDeth - ------------------ ❑ Privy: Distance from nearest well---._______t________-----------------------_ Disfance.from nearest.building:._._____._._______-__.__.-------------- ? --------------------------------------------------- ❑ --- r--------------------- — — Distance to nearest: of lne------------- +�06 - I � � i k Remode4ing and/or repairing (describe:- = _ --- f4jro r - ------------------------------------------ -----------------•----------•------ - = ---•---------------------------- -------------------- --------------------------- --- ---------------- 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, r r (8 r Contract -- o or) (Signed) ----- �" -------=-----------------------------= n------- -_---------,.r_ M (Plot pian, showing size of lot, location of system in rela#io o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY `I ----------------- DATE 1s� 6-5777------------- APPLICATION ACCEPTED BY---"----�--�.-K-` ,- ------------------- ---"------- REVIEWED BY------ --------- ------------ ------- --- ----------- ----------- -------- --------------- --------------------------- DATE------------ ------------- ---- ---------------------- - -- I BUILDING PERMIT ISSUED----------------------------------------------------------------------- ------ --- ------- ----- DATE------------------------------------------------------------- Alterati6-ns and/or recommendations:--------------------------- --------------------- --------------------------- -------------------- ---------------- ------------- ------------------------------- \----------------------------------- ...... ...... ------ -- ---12�,v LL I'""INSPAA-_ Qate. / .-.}, a ---------------------------- FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 205 West 9th Street S 1601 E.Htiaelfon Ave. '300 West Oak Street 1Y Stockton,California Lodi,California Manteca,California Tracy,California F.P.00.