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FOR OFFICE USE: A)./_1�---------------------- "'--'- s-:.----.-- �: APPLICATION FOR SANITATION PERMIT Permit No. ---.-.-....�_... -.. - --- Date Issued �_.: - (Complete in Duplicate) ...... 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 w4herein described. This applicati:in is made in compliance with County �Ordiinance No. 549. - JOB ADDRESS AND LOCATION_- .vl- ------------------- Q�-• _ r-�5� +---- 1J/`�, - 1� � --- - r-- ------------ I -- Phone------------- -Owner's Name Address � . � f! f t r�y�e Contractor's Name-__-_ ---------- b - Phone will serve: Residence Apartment. House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L-Number of bedrooms'_ Number of:baths I--- Lot size7---.. ----------------- Water Supply: Public system ❑ Commun.iity system ❑ Private �pth to Water Table4_T ft. Character of soil to a-depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Il'Tnardpan ❑ Previous App[ica+ior]* Made: (If yes,date----------- --------1, No W-- ew Construction: Yes P-`go ❑ FHA/VA: Yeslj;� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if public sewer is available within 200 feet.) I�' . pI Septic Tank: Distance from nearest well -Distance from foundation----------------M terial- - -r' -- ---------- No. of com artments_�__�-----A Size 106____ Li uid depth__ .Ca acity-I p 7( _ Disposa �FId: Distance from nearest well._S }----Distance from foundation&_ ------.Distance to nearest lot line--,�---.----- IV Number of lines-------I----- - LgngA of each line------------�0_�-------.Width of trench---1. ---------------- Type of filter'material-11, --"__- epth of filter material--n/- !-----_.-Total length-----...--.47------------------------ Seepage P' : t Distance to�neares# well_�)-0-0,_1-----Distance,fxom foundation_'_/�_.�-----.Distance to nearest lot line- �----. Number of pits-----I--------.---_--Lining material--- . Q-f�..Size: Diameter-3."--------Depth- -- �-_ -- Cesspool: ( Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------.------_--------------- ❑ Size: Diameter------- ------------- ----------------De th-------t----------------------------- -- S• -- ------Liquid Capacity----------------------------gals. 91 Privy: Distance from nearest weft_ ------- ----Distance from nearest building--------------------------------------- i ❑ Distance to nearest lot line--.-_--_,_----.-.---_---._ Remodeling and/or repairing (describe) - ? �� T/C � + '' -= ----------------------- i --------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------9----------------------------------------------------------- ------------------------------------------- ------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ I hereby certify that [ have prepared this application and that +hb 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)----•----- a- - ��-- ------------------------------------------------ + (Owner and/or Contractor) BY:----------------- -- - -- - - ( ) -� Title----- ------------- [Plot plan, showing siz o , location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY / - ----- --- ---- ^r------------------------------- DATE-- ---- T,- 7-1--------------- REVIEWEDBY----------------------------------- -------------- ----------------------------------------------------------- DATE------------------------------------ --- BUILDING PERMIT ISSUED---------------------------------- ----------- ---------------------- .-- DATE - .:----- Alterations and/or recommendatip`:.- I / 6` Y v : ----- - yz -----'-------t- -- --41--r----"t",----------F--=-r"-'-�-=- ----�`-v�-. l-', s_"`�`--"�•--�-�-------- ------,-- ---- --s--r---.. ----——--- ,['cmc ' --•-----`tA �+ ----- ---------------ll--------.-E.----------------- ---------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------•------------------------•----------------•---------------------•-------------------'-------------------------------------' r. FINAL INSPECTION BY:-/ -- '`� -------- - Date. - --------f- /-----�--/--��-------- ------------- SAN 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.F.E O. ;