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Foy; ylcE use: 7� 97)- --------------------------------------------------------- ------------------ -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 63 --------------------------------------------------------- (Complete in Duplicate) Date Issued __/ bla ... ................... ................................. This Permit Expires 7 Year From Date Issued Application is hereby ade to the San Joa in Local Health District for a permit to construct and insof 0 tall a wo herein described. This application ism a in ompliagce�vyy h ounty Ordinance No. 549. ( � 77- JOB ADDRESS AND TI��ON._l/VV ,a_ .- 1 _ ........ ---r4-`---------- - '-- - ----- ' Owner's Na --- --------------------------------- ----- Address------ -R,,------ -- --- ------ ------- Contractor's Nam _ __ __' - l __ -/ -Gam .-._ __..__ Phone.. �irr_. �`--__ Installation will serve: Residence Apartment House ❑ Commercial t❑ Trailer Court ❑; Motel ❑ Other ❑ r Number of living _ units: J__-* Number.'of bedrooms,_,,,--- Number of baths _----.ytot size : - ------------ Water Supply: Public system ❑;" Co+munity systemPrivate ❑ Depfh to Water Table .......... ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [J Clay E❑ Adobe ❑ Hardpa Previous Application Made: If es,dates-------------- I No New Construction: Yes o, FH : Yes No PP I Y --- ❑ � �❑ A�� _❑ _. TYPE OF INSTALLATION AND,,SPECIFICATIONS: - T (No septic tank or cesspool permitted if publ' sewer is available within 200 feet.) • -, a Septic Tank: Distance from nearest well_.--_Distan p from fou�`�tion:/Q:_ tenial--- ... T' _________________ Vf No. of, compartments_... _ --- Size - _ _b�__Liquid depth__ _ ----------Capacity_/Z_-P-_C9__ e i, I Disposal Field: Distance from nearest well_t- --------Distance from foundation_10-.________-Distance to nearest lot line___ _____ _ r Nuriiber of lines____ _____ Length of each IinefQ_e_�__- _dr_.Width of trench- --76L, � Type of filter mafierial_ ___ _________ ___ __Depth of filter material-._�_7 r.-__--_-___Total length__!:_�_0__r_____--____--___-._. Seepage Pit: r .Distance.,to•nearest well-----_------- -------Distance from foundation------------.------.Distance to nearest lot line_____________..._ ❑ Number of pits----------------------Lining material---------.-._-„- - Size:.Diameter--_--------------.�----Depth--------------------------------- ' 1 Cesspool: Distance from nearest well-__---_----_-._ Distance from'foundafiion= -_ __.----Lining material_____________________________________ r ❑ Size: Diameter--------------------------------------Depth----------- - Liquid'CapacitY - gals. Priv Distance from nearest well-_ ._.._Distance from nearest building ❑ Distance to nearer t • !I------ ---- Remodeling and/or repairing (describe :........DQf 4-[CAT7'0-/%,1----- -----------------f- - -------------- --------------------------------------------- a # _EAS CRtj >, RM_>t ------------------------ ---------------------------------------------------------------------- --------------------- ------ + -------------------- ------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Jo yin Local Health District. t (Sign ------ ._ �_ (C._! w I or Contractor) } T - = _ = _ - . Title - ..... BY� { ) (Plot plan, showing size of lot,.location of system in relation t wells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... R.0----- - - ---- -------- ------ ---------------------------------------- DATE---- �` 1 REVIEWEDBY--------------------------------------------- --------- ---------- ----------------------- ----------------------- --------- DATE-------- ------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------ ------------------ DATE------------------------------------------------- Alterations and/or recommendations------------------------ ---- --- L..1 -------•------------------------------ --- ---- ---------------- -- ----------- ---- ------ ------ - •------------------------------------------------------ - - - - -------------------------•- FINAL iNSPECTI . .. . -- -------------- --- Date --- --25- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cu.