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FOR OFFICE USE: - AP- PPLICATION FOR SANITATION PERMIT Permit No. .__.L.7.:;�__2- 4-------------------- -------------------- (Complete in Duplicate) Date Issued ____Y(74,y ---- ------------------------------- --- --- This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the,4ork herein escribed This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-- "-• - -AA7 4P9 Owner's Name ------------------------------- ---------------------------------------__ Phone.-,.------------------------------ -------- Address ---- - - c ----------------------------------------------------------I.... ------------------ . ' Phone----------------- Contrator's Name--------- Installation will serve. Residence E] Apartment Hou"se-E] Commercial ❑ Trailer Court A�Motel Ej Other 0 Number of living units: _/__ Number of bedrooms Number of baths J--- Lot size ----------------------------- Water --------------------------- Water Supply: Public system E] Community.system E] P-riva te �epth to Water Table 4 W- W Character of soil to a depth of 3 feetr"Sand E] Gravel tD Sandy Loam El Clay Loam El Clay E] Adobe ZK'H'ardpan ❑ Previous Application Made: (If yes,date____..___..,_. No U5,--New Construction. Yes E] No g?`0_FHA/VA: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /I Septic Ta Distance from nearest well--lev- 41-e-Distant igm foundafion_._,Z%.-!9-------Mat e.�al__e_&_Ag�— --- -No. of compartments_-- ---Liquid clepth__'!k ______________Capacity--*- --------------- .1 dor de W_._'Distance from founclaflo ... Distance to nearest lot line--—------- Disposal Field: :'Distance from nearest well �-Number of lines---- Length of each line_____ ;*--- __Width of trench-A.-I,------------------------- Total len "Type of filter materia Depth of filter'rnaterial_ 6�------ length_____ -- __________________ G'___------- e, Seepage Pit: Distance to nearest well._1,71-e----- -Distance from foundation-44.... iistance to nearest lot line_.:� -------- - material _ __ Size: Diamete K.?*7-------Dep _,_27 Number of p;ts.-'.- _'Lining r�ate th ----------- Cesspool: Distance from nearest well_________________Distance from foundation... ----------------Lining Size: Diameter material.__-__-_....________.___.....________ El ------------ . .......... G------ --- -- ---- Depth--------------------------- Liquid Capacity----------------------------gals Privy: Distance from nearest well_______________-..,__----__z---------------------Distance from nearest building------ -------------------❑ - Distance to nearest lot line------------------ --------------------------------------------------------------- Remodeling and/or repairing (describe)! *.,a- ��------------------- ---------------- __ ----- ----- -----------m-........------ ---------------------------------------------------------- ---------------------------------------------------------- ------ -------------------------------------------- ---------------- --------------------------------------; - -------------------------- --------------------------------......I-------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 r les and r gul tion f the San Joaquin Local Health District. (Signed) 11 -___1 4 �p --------------- ----- - --- --------------------------- -------------- ---------- ----------------- ---- -- --------------(9.MM=xiCV*r Contractor) :�o By:------------------------------------------------------------------------- - ----- - - - -- - - - ---------------------(Title)_ --------------------(T i f I e) /.-- —----------------------------- ---- (Plot plan, showing size of lof,loca+ion of system i afion to we s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--Ik,,./---------- ------------- DATE------- REVIEWED BY---- -------------------------- ------------------------------- ------------- ------------------------------------------ DATE-------------------------------- --------------------------- BUILDING ATE-------------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------- t------------------------ --------1___ DATE.------------------------------------------ ------ ----------- --------------- -L - - Alteration� and/or recommendations: 7__ -------------- --- ----- ---- ------ - L --------------- —------------- ------ -------------e� ....�14:--------- -----------------------------------------------------------1------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------I-------------------------------------------- --------------------------------------------------------------------:---------- ------------------------------------------------------------------------ --------------------------- ----------------------------------------- ----------------------------------------------------------I--------------- -------------------------------------------- - --------------------------------------------------------------- •----------------------------------------------------- ----------------------------- --------------------- 771 ( '17 FINAL INSPECTION BY------------------- --- Date---- -------------------------------------- -- --------------------------------- -------- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Howelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 5-59 3M 3-63 F.f-,Ca.