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FOR OFFICE USE: -------- ---------- . ------ / Permit No. I 3 APPLICATION FORSANITATION PERMIT G --- ------11' _// C ___- (Complete in Duplicate) pate Issued �� z'"``� This Permit Expires 1 Year From Date Issued Applica i n is here y 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. Q JOB ADDRESS AN O ATIO -- ------ - - - ----- - - -�'�-'P�----"----------- ----------- ----- -. Phone------------------------------------- Owner's Name- Address------_------- -------- ---,5 --- -------------------------------------- r Contractor's Name---- ------ Phone----------------------------------- Installation will serve: Residence A artment House Commercial E] Trailer Court [I Motel El Other E] 07 Number of living units: _-f--- Number of bedrooms, _ Number of baths 4-_ Lot size _.��A--- Water Supply: Public system ❑ Community system ❑ Private epth to Water Table 74,0,ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,date---------___,-------) No t 'Jew Construction: Yes [ ❑ FHA/VA: Yes ®�—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer er is available within 200 feet.) f ----Distance Wm foun dVion.- J Septic Ta k- Distance from nearest we �...-:__.Mater al-__ ---"-- _-- No. of compartments----- ----- Size �7 7?' ------Liquid dept ....�W_0. ---------Capacity-_�Ki ---------- x Disposal Field: Distance from nearest well..e.e--.--Distance from founds ion. -`, Distance to nearest 1� line_1.1d...---.-.--- Number of lines_."._"." -"�- ------------ ----- en th of each line_,-"---"-----------.Width of trench.- .""_ 9 i Type of filter material -- De th of filter material.. ._?-- ..------ Total length_ - Op Seepage Distance to nearest well.---��49'Distance fr fou ation.-x7 ......"_.Distance to nearest lot Una ~ r `07 Number of pits.-.. . _---- Lining material. Size: Diameter_r �-�_._....Depthm .-� / --' O k Cesspool: �-�-�-Distance,from,nearest well-----------------Distance from foundation_-------------------Lining material-_.__.."....-__......__.."......_.....i��v x+ ' -___ Liquid-Capacity----------------------------gals. ❑ Size: Diameter------------------ depth----------- mm= === Privy. Distance from nearest-yell-- -------- --------------------------------------Distance from nearest building-------.....--___.-----------------------. ' ❑ Distance to nearest lot line-------------------- -------------- --------""--------------- '1 - ---------- -- --- ---------------- - - --------------------------- --- �f -------- ^ys Remodeling and/or repairing (describej:.._._`.r--- ? ' �J --------Y------------------------------------ ri y -- -------•-----`-------------------- ------------ - - -- ------------------------------- -------------------------------------------- \i ..."_-_...- . " ................................"__...._-.-"...-__."_----..._._-.".....---....._..._---.._.-.----------------------------------- -•---- — ---------.-- . , 1 hereby certify that I h ve prepared this application and that the work will be done in accordance with San Joaquin County, . ordinances, Stafe.laws, and ules and regulations of the San Joaquin Local Health District. ------ -- ---( 0'' Contractor] ----- -- -- --- -- --- - -- v Title - ----------------- By:------ ------------------------•----------------------------------------------- --- (Title) ` (Plot plan, showing size of lot, location of,system in re on to wells, buildings, etc., can be plac9noeveitie side). FOR DEPARTMENT USE ONLY, f APPLICATION ACCEPTED BY------- --=----- ----- ATE--------� ;--------- (---------------------- ------------ REVIEWED BY A� / ` '-----------# DATE------------- ------ I ------------ --------------- -- BUILDING PERMIT ISSUED---------------- -- DATE -------------------------------------- r. `ry ---i l ---- - Alteration and/or recommendations:.//,tom..'`41 _.... _�lam_- - =--• •-- --'- - �. r Lr x .. -,C-c.��[- �------- - �_ -, --- ------ --------- r • __ ff ------------------- / '� -- ---- -------- ------------ --------------- - ---------- --- ------------------------------ ------ ----- ----------- --------------------------- - ---------------------------- ------ ---------------- ----- f Date------ FINAL INSPECTION BY:..��; -------------------- ----------- - � t - SAN JOAQUiN LOCAL HEALTH DISTRICT" fi �• 1601 E.Hazellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca;California Tracy,California r.a.co. r