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II it ✓ II APPLICATION FOR SANITATION PERMIT Permit No. .-.`.-?..1 . (Complete in Duplicate) Date Issued _-_. c"o 1'I�pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install theyo her in descr*bed. his ap lication is made in compliance *Contyrdinance No. 549.OB ADDRE 5S AND ATION -------_q-t-wner's Name-------•- �- � -------� ...--=''"'�-------------------- --------- Phone------------------------------------ ddress......................•--..........---- -- 1-- ----•-- ---------------- Contractor's Name--- ••'• ! `� '� !tj - ------ --------------------- Phone---------- ---- llnstallation will serve: Residence &Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ .__ Number of bedrooms -,- ?- Number of baths ---/__ Lot size Al IIater Supply: Public system F1 Community system Private ❑" Depth to Water Table _ 4,ft� i Illi haracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: Yes 0 No New Construction: Yes �No ❑ FHA/VA: Yes R;---No ❑ `TYPE OF INSTALLATION AND SPECIFICATIONS: li (No septic tank or'cesspool permitted if public `ewer is available within 200 feet.)) .$eptic Tank: Distance from nearest well��_____Distance f/r°m foundation____f!c°'____.____,Maferi�L j_�(��--� --------------'� No. of compartments----�,___-------------Size___�(!�__��.---Liquid depth------ Capacity..,- �' #_�— ",-isposal Field: Distance from nearest well__*�.._.Distance from founclati n_--�*O___.— Distance to nearest lot line___ - Number of lines___________________ LenT th of each line_..__01_________ � Width of trench___,,A �� g -� Type of filter material__, _ Depth of filter material_./4___-------Total length--------7V--------------------------(11T !Seepage Pit: Distance to nearest well___ p____Distance fpm oun ation____IV______-Distance to nearest lot line__/_ -----__ i Humber of its---.__ Linin material_,t` -Size: Diameter__ __��_______-De th____ .._ _ r� P g or-- - --- P - ---•-------------- v esspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material__._______.____.__.____.____________. ❑ Size: Diameter------------------------- ------Depth----------------------------------------------------Liquid Capacity-------------- - ---------gals.{ tiff jjj rivy: Distance from nearest well--------------_----------------------------------Distance from nearest building------,-__.______________-______________. I ❑ Distance to nearest lot line-------------------------------- -----------------------, , I I ti -- - --- ------ � I emodeling and/or repairing {describe:------- -----•----•------------------------------------------------------------------------------•---------------------------- ---- ------- - - -= ----------------------------------------------------------I I--------------•----------------------------------------------------=--------------------------------------------.-.-..--•-------------------- -------------=----------------------------------------------------------------- --- -------- -------------------------------------•--=--------------------------------•----------------------------------------- ------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County rdinances, State laws, aydr les and regulations of the San Joaquin Local Health District. I� _ t Signed) --- - t r-- --------------•----------------(Gwner-and/or;Contractor) i BY: -------------- �l r � --(Title / moo' Plot plan, showing size of t, location of system in relation to wells, buildings, etc., can be placed on reverse Oe). F R DEPARTMENT USE ONLY IKI PPLICATION ACCEPTED BY-------------------------------- - ---------------------------------------------= DATE------ ----------------------------- iREVIEWEDBY-------------=------------------------------------------------ ----- -------- --------------------------------------- DATE k BUILDING PERMIT ISSUED-------------------------------------- _-- _ DATE-------------_--_ _ Alterations and/or recommendations:--------------------- •-------------------- -- - -------------------------- --- --------- '�f1r` ---••amu( -Ji - --- - - ___ - ,a ". -r,. - (vim "__ . / L �� '71 ' --------------------------------------- FINAL INSPECTION BY---------------�----__----------------_--.----_---.--___ Date_...�_�._/-7/ / f------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 Wast Oak Street k 132.Sycemora„Street 814 North "C” Street j Stockton, California Lodi, California Manteca, California Tracy, California E5-4-2M Revisea 1.57 F.P-CO.