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a { WMICATION FOR SANITATION PERMIT Permit No. (Complete in uplicate) // // ` This Permit Ex fires 1 Year From Date Issued Date Issued .__�1- d16 Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal!athe � heribed- I This application is made in compliance with County O d}nance No q 549. rein ATION ,- JOB DS--_ A----N-•-D- -Ott I ___�i_%c- - - - .01 f�-------- j - weName ---------------------------- Address------------ _ --------------------- ------ --- -- -----..__ Phone--- 1W ,i --------- - • ----•--------••------------------------- -----•------------------•-------.... Contractor's Name---------------"__-_ 1 p --------------- Phone_ Installation will serve: Residence Apartment House ❑ Com mercial ❑ Trailer Court ❑ Motu ❑ Other ❑ Number of living units: � Number of bedrooms _- Number of baths __li ____ Lot size _-"__ _"_ (�� I Water Supply: Publics stem ---•-------•-- Y © Community system ❑ Private �] Depth to Water Table Character of soil to a depth of 3 feet: Sand Gravel ❑ ❑� Sand Loam ❑ Clay Loam ❑ Clay [] Adobe E Hardpan ❑ Previous Application Made: Yes No 91 t ❑ New Construction: Yes ,Q No ❑ FHA A: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: y.Distance from nearest well-/kLAD t�-Dista e)fro fou dation_- _�_11 f- `� -------.Material_-rC {G�Tz13t1 ® No. of compartments. �-"_ __ - ,/• - " Size?-'}- * --------Liquid depth--------------- --------Capacity C c --------- Disposal Field: Distance from nearest well--/V14rVtQ__Distance frolimln foundation_-__� r :l r ---_---_Distance to nearest lot line Number of lines-_----•----�_ r� ____•-_-•--- --- of a lch line----' �------------------Width of trench.-_1124' , Type of filter material"_ , ___Depth of fil Ie r maferial--_-"�`9___ jj --------Total length---- !- �_ ------- ------- n ` Seepage Pit: Distance to nearest weil__ v Distance faro foundation___1-0_�f--.pisttanceito nearest lotlline-__ i_".-• .® Number of pits._'-- ---C"-""__ __Lining material ----�. Size: Diameter Depth --------- 1— Cess Cesspool IM ---------- �. p Distance fiom nearest well_ _____-- ---Distance from foundation-__.---___"-_--__".Lining material-"_._____.____-____. ❑ Size: Diameter- __ _ __ . ------------depth------ �-- -- ------Liquid Capacity gals. -----g Privy: Distance from nearest well I�� _ _Distance from nearest buildin ❑ Distance to nearest lot line —_ g----- ------------------------------------ C s: r IM Remodeling and/or repairing.(describe :-------_-- ---------------------------------------- 11 ----------------------- -------- ----- _ --------------------------------------------a ---- ! -"_--_"-- ---"___ JLr- ---"_"--"___-•----_~--'---- "-----•-----'------'--------------------------------------------------------------------------------------------- •----------------------------------- I -."_."-_"-_"- -"._..- .--"__."- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' r ordinances, State laws, and rules and.regulations "of.the.San-Joaquin local Health District. (Signed)--�- Zt�- Gly --------�r-----------------------------------------------------(Owner and/o}• Contractor) By:. Ti+le (Plot plan, showing size of lot, location of system m relation to wells, b ildings, etc., can be placed on reverse side). • 11 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.--_________________ ,� REVIEWED BY _ ° - ----- - ------�M- -- ------------------- DATE" --- ---------------------- - BUILDING PERMIT ISSUED------------------= --"- ------------------ DATE ---------------------- ------IIM l' -- AT -E Alteratio s and/or recommendations-------- -------------------------- --------- ---------- _1__= �- � "` _ r ,! r �rZa _ G------ IN--------- ;8i------- - -- ------------------- -------- — _ � FINAL INSPECTIONS f . . t �r( �/`-Date- - l�3 F 6/...•----�-- -- - �- .-.�•� +f -C�--v--/----- - � ' --------------------- SAN ------ -------- SAN JOA UIN LOCAL HEALTH DISTRICT "- 130 South American Street toekton, al;fornia 300 West Oak Street 132 Sycamore Street 814 North „C', street ,. r� Lodi, California Manteca, California 71z--6-16-,/,• J / Tracy, California ES-9-2M ised B-'S9 F.p.Co / k a �•.-.�"r'� .e Gem�e-e�� ^71