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FOR OFFICE USE: ____________ I �b___"'-.' _1� �_f................... APPLICATION POR SANITATION PERMIT Permit No. _._f .�_� ... f ------------------------------------------------ -------------=-------------------------- --------- (Complete in Q Plicate) f' Date Issued ----------"-------"---------"-------------------- 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. 54 JOB ADDRESS AND OCATION------G.'-�-C- �__fTiC__1 1--------- --------------------• Owner's Name -------- ILII-----�J-�--i,-P = 4 ---------- ------------------- •-----------------------------•--•--------------------------.-. Phone ------------------------------------ Address-_....._.. ..... ------------------------------•----Address-_...-•--••..... �S/ �'`� � �------------- - - ..... --.....---------------------------------- Contractor's Name---------------------------------------------------------------- -- Phone._`...-= i Installation will serve: Residence [�] Apartment House ❑ Commercial [j Trailer Court (] Motel ❑ Other ❑ Number of living units: Number of bedrooms _ ___ Number of baths ....!-_ Lot size ------- ___.�-�_------`� '-_----------------- Water Supply: Public system ® 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 ® Hardpan 13 Previous Application Made: (if yes, date --------------------I No ❑ 'New Construction- Yes Eg No ❑ FFIA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available with'in`'200,fee+.) Septic Tank: Distance from nearest well ------- ___ Distance from foundation ---- /0 --- ------ Material--_ -------------- ® No. of compartments___--_--, ___Size__. __` � _ _ :__.Liquid depth------ .r ---------- Capacity---- -nom Disposal Field: Distance from nearest well_.._ -..___----Distance from foundation... 1_9 ---- ------- Distance to nearest lot line _--_6.. j Number of lines ------ -_.. Y _. -g . Length of each line _.-3!:�Wid+h of trench ---- J...7�'-....................... Type of filter mate rial-_�__: __-Depth-of filter material---../ 1_`- -------- total length ------- X_V�i - ---------------- � f - - Seepage Pit: Distance to nearest well ----- _---------------- Distance from foundation -------------------- Distance to nearest lot line ----------------- F-1 p g Depth - Number of its -------1------------- Linin material.-------•- ----- ----Size: Diameter Distance from nearest well ----------------- Distance from foundation -------------- ._=__.Lining ___________._ ❑ Size: Diameter--------------------------------------Depth----•----------------------------------•----------- Liquid Capacity_ --------------------------- gals. Privy: Distance from nearest well --------------- ______________________________Distance from nearest building ____-__--._----__-.---_-f___:-_-.---.-._-. ❑ Distance to nearest' lot line ---------------- ---------------------------------------------•---------------- ---------•-------------------------------- -----==------------- Remodeling and/or repairing (describe): ----------------------------------------------- ----------------------------------- .----------------------------------------=- ------ y ---------------------------------------------------------------------------------------•- ---- •--------------------------------------------------------------- s 'G Thereby certify that Fhave,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. r (Signed)----__yil ._.f7/.------------------------------------------------------------------------------------------(owner and/or Contractor] f .. = By:---------------------------------------------------------------------- '--------- ----------------------- plan, showing size of lot, location of system in relation -to• -wells buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ... APPLICATION ACCEPTEDBY - -- -- - -------------------------------- ------------------------------ DATE -------- -------2 _Z ---� ..&-- ------------- REVIEWEDBY--------------- --------•----------------- ----------------=-- ----------------------------------------------------- DATE ------------------------------..--------------------------- BUILDINGPERMIT ISSUED --------------- ---------------------------------------------- --------------------------------------- DA -TE ------------------------------------------------------------- Alterationsand/or recommendations: ------------------------------------------------ --------------------------------------------------------------------------------------------------------------- -------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- =------------------------------------------ -------------------------------------------- __ ------ --11 ------------ -------------------------------------------------------- ----------------- 1 -------------------------------------------------------------------"---------------------------•------------------------- ---------------------------------------------------------------------- FINAL INSPECTION BY :t'�------- Date ------ �---- � -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 304 West Oak Street 124 Sycainore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California Ce•9 REviZBC a-69 r.P.CC. ]M 6.60