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FOR OFFICE USE: -- -14 _ _. -- - ' APPLICATION FOR`SANI-TATION PERMIT Permit No. ------- ------- Z- --1 ---- ------ ----- -- (Com Plefe•in Duplicate ) Date Issued 2-�1 ------------- --------.-----.------------------- I 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 LOTION___________________ __ ____________ '� •----•-------- Owner's Name-----Z. _._ ------- ------------------------------ -- --------- ----------------------------- -- Phone.,7s ,�, 53 Address / ,If =•...... - . 2 �} Contractor's Name, . - -- ---------__t:t ---------------------------------------- Phoneo-VI..1?d&7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: a-- Number of bedrooms Number of baths 42 __ Lot size -----%a__._a- '�. _-4_X2_______________________ Water Supply: Public system JJ Community system ❑ Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe V Hardpan ❑ Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes Ik No ❑ FHA/VA: Yes ❑ No ❑ 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_,5'0.......Dista ce`from foundation__/s2_....._.__.Material ___ _,f• -.- - _.__.-- . ❑ No. of compartments_.._____..,,,___;_._._.Size_ ! ,Q, ;.(,__Liquid depth. _-;C Capacity.._ Disposal Field: Distance from nearest well-so------ .._Distance from foundation_Zl,;--`-----...Distance to nearest lot line_6----------- Number --------.-Number of lines__.._ _._ ___ -_Length of each line--_ W`____...._-___.Width of trench-___ --- Type of filter material r__ _:c.____--Depth of filter material—/9----------____Total length--------213,06------------------- -SeePaAje�F: Distance to nearest well__j. ....-Distance from foundation....,L``A0.........Distance to nearest lot line-1-7-__-__--- .S. Number 0 g (� -� 7 y --- Size: Diameter-- `-,jb- ,Z-._Depth.....e- �•1 `Q6 i a Linin materia ; Cesspool: Distance from nearest well ________________Distance from foundation___-___- _.------ _.Lining material----.-----------.-_--_--.---__------- ❑ Size: Diameter- -- -------------- ----------------Depth----- --------------------------- ------------------Liquid Capacity..-------------------_----gals. Privy: Distance from nearest well----------------------------------------..-------Distance from nearest building------.------------------_________________ ❑ Distance to nearest lot line---------------------- Remodeling --------------------Remodeling and/or repairing (describe):------------------------------- -- ---------------•-•-------------------••------------ ----------•------------------------------------------------- ---------------------------------------------------------- -----------------------------------------------------------------•---------•----------------------------------------=-- 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 Joaquin Local Health District. (Signed) =� t ----(Owner and/or Contractor) By: --- ------------------------- -------------- ----------------------.-(Title)--------- ------ ------ ----------- (Plot plan, showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ----------------------------- APPLICATION ACCEPTED BY_ _.__c_�I"77 -�' ----------_ .: ------------- DATE--��-'�--��- -=-�,7------------------ REVIEWEDBY--------------------------------------- ----------------------------------------------------------- DATE BUILDING PERMIT ISSUED------ ----------------------- -------------------------•-_-------------------- ---------------- ATE_ _1/-------- Alterations and/or recomm%endations:� _ ____.___.___ _ .. _ c ... � .t,r/�- -rLrx.�c ..� - ------------------------------------ ---------------- - ----- ------ - ---------------------------------- ............ --- ---------------------- ---------------------------------------• ----- ---------------- ----------------------- -------------------------- FINAL INSPECTION BY:._ Date �- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press