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FOR OFFICE USE: �: -- ----- I-V�6 ------------- ' Permit No. ../�/�-----•-- `oAPPLICATION FOR SANITATION PERMIT--- ---,--- ` (Complete in Duplicate) ---Date Issued _Z1 ------ --------- This Permit-Expires 1 Year From Date Issued 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. JOB ADDRESS AND ATION------ �" ------- ------------------------------------ - J,47,-4 U ------------------- ---------.- Phone------------------------------------ --------------------------------------- R Owner's Name ------� --------- --- � - ----=-->-�----- --------- --- -- - �j _ Address------------------- fi--+ ----•--- ----- ' Contractor's .Name--- . . one.. _ Ph Installation will`serve: Residence ❑ Apartment House r; Commercial ElTrailer Court ❑ Motel ❑ Other [I 7 Number of-Iiging units: -" tuber of bedroom ,&.- Number of bath&&---- Lot size _- cr� -- � iQ---------------- ----- m ---- r 1. r Water Supply: ' Public system Community system/El Private ❑ Depth to Water Table -------- ft. , Character of soil to a depth of 3 feet: Sand ❑ avel ❑ " Sandy Loam El Clay Loam )] Clay ❑ Adobe �655ardpan ❑ Previous Application Made: (If yes date_..._.__.._._:- ) No ew Construction: Yes E] No HA/VA: Yes [3 No�' € it fi TYPE OF INSTALLATION'AND SPECIFICATIONS: {No septic tank or cesspool pgi mitted'if public sewer is available within 200 feet.) - � ( 'Y � sty I , 2. . Septic Tank:' ,t Distance from nearest well-----------------Distance from found ation--------------------Material------.:-_--__.__---- ________------.__..._. � �} No.ofd compartments---- _--------------_.__Size---------- ---------------- Liquid depth :' Capacity----------------------- /771 ---------- --------- I Disposal F Distance from•'Barest well__-__'fir-Distance from foundation_/ ------------Distance to nearest lot line_.____._.. Number of lines" ---------------- ----Length of each line.- _!---------------•.Width of trench.. -�r._____-______"--•-- § ,wwov A /l0 TX Type.'of_filter material____%_j0dKti 5epth of filter material........I I/�----Total length__3d_/-------------------------------- dQ Seepagy Distance to nearest well__,". __Distance from fo ndation__ _0_ _____.Distance to nearest lot line_________________ ff Number of its Lining Size: Diameter._. // �� De tn_.D,4-'_ PY /______"V� azls` Distance from Weary Linin material-- C- #rt p ""V�~t ' P est weii-----------------Distance from foundation.-----------------. i�n ng material----------------------- ---------- p gals. Cess ool. ❑ Size: Diameter----- ------------------------Depth------------------------------------------------'----Liquid Capacity--- - --------------------9 1 Privy: Distance from nearest well-------------------------------------_--:----- --Distance from nearest building----------__-______-----____.._------- ------- ------ --------------••---------• ----------------- ❑ ^S f Distance to nearest,lot .line------------ ----------I and/or-repairing (describe]------------------------'��'�•a-�',--------- - + ._ -------•----------------------------- r --------------- ------------------------------ - ------------------- -N .r ----------------------------------------------------- ---------------- I hereby certify that I have prepared-fhiiapplication and that the work will be done in accordance with San Joaquin County ordinances, St a ws, and rule reg ations of the San Joaquin Local Health District. ' SI Wed - 'O- --------'----- -- ---------------- --------------- ----------------- ----- .(Owner and/or Contractor) - -- - -- - -------- --- By-------------------- -------------(Tale] - --------------- dings, ---:--------- (Plot plan;showing size of lot, I atio of system in relati�toe 'dings, etc., can be place on reverse side).._ -� 1 � FOR DEPARTMENT USE ONLY j --- DATE- , 1- I -----------=--- ----------------- -11-'-1� .P. APPLICATION ACCEPTED BY - �,--k � '-------------------•--- -- � ------...--------------------- - - REVIEWEDBY---------- j----------------- ---------------------------------i----------------------- •i-------------------------- DATE---------------- --- ------ If�1 ----- r DATE--------------------------------------------------PERMIT ISSUED---------------•--------------�Jf7 Lf -- _ r=------- ----- Alterations and/or recommendations:- _jl- =7 --"---- -- Wi`'` 't-'- r ` ' }p `J ` ----------------------------------- -•------------------------------ ----------I-------------------------------------------------- --------------I---------------- --------------------------- r: ----------- ------ ---= ------------------ --------------------------------------- ----- i FINAL INSPECTION BY:.... ----------------- --------- Date. 1 #= F t a SAN JOAQUIN LOCAL HEALTH DISTRICT x 1601 E.Hazelton Ave. , 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California ? ' Lodi,California Manteca,California Tracy,California F.RCC. pie