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':OR OFFICE USE: ------------ ------------------------ APPLICATION FOk SANITATION PERMIT Permit No. ------- ------------------ ------ (Complete in Duplicate) 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-destrbed. This application is made in compliance with Contyy Ord,inncerNo. 549. lj?D� SIAL fr�fot XT [/1 ------------------------ JOB ADDRESS AND LO ATION_-_____-- _.-r � L� -------- ------------------ Phone------------------------ I�----------- Owner's Name_____________,___. _ � ' Address -------R ��5 -------17-g --- � { ----------------- ----- � iM -- - -------- Phone ----•--- •-- Contractor's Name----C:�,t!_N- .X ---------•----- ---- ------------------------------------•----------- -------- - - ------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f ----- Lot size - C.I ' II Number of living units: __t-__._ Number of bedrooms,_.- Number of baths 11 Water Supply: Public system 171 Community system ElPrivate Ej-1Depth to Water Table/-5-- ft. Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ Previous Application Made: (If yes,date---------- } No,O� New Construction: Yes ❑'lo E] FHA/VA: Yes� �No El TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer Is available within 200 feet.) I� Q .._Distance from foundation------ Material--- Septic Tank: Distance from nearest well----------------- C- - S___--- /�X_ •--Liquid u Id de th---- 1//-----------Capacity-122-00-- --- No. of compartments_. �- Size__;[__-r__---- q p Distance to nearest lot line___ `^ - ---------- Disposal Field: Distance from nearest well._.--Lam._----- Distance from foundation------ ----��- ------------------Length of each line__�7 =J'_`1--� Total hien length of nch Number of lines_________ 9 a Type of filter material_- -0 C_�- 1 ____Depth of filter material___._ly_--.----- 9 Seepage Pit: Distance to nearest well__-______----____--Distance from foundation -----------Distance to nearest lot line.._I�_-_____.__._. -- ----Size: Diameter-- ---------Depth--------- ----------------------- 171 ------- -------------- ❑ dumber of pits ----------material____.--__-_. Cesspool: Distance from nearest well-----------------Distance from foundation Size: material__.-.._._____.______ ..___________ P ___-___Li Liquid Capacity • ❑ Size: Diameter------------------------- -------- Depth -------- -------- -------- -------- - G ---------------------� .....gals. ' Privy: Distance from nearest well------------------------------------------ Distance from nearest building-___---_.._-__ _-------------- . .____-__i- ❑ ..Distance to nearest lot line-------- --------------------------------------------------------•----- ----------------------------------------------------- 'I Remodeling and/or repairing (describe]=-- TAN-6�-----51-; " -------------- ' ' i - ------------------- --------------------------------------------------------------- ------------------------- -- --------------------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. Si ned —,rt-_/��.f --- ............... (Own( and/or C n+ractor) _�.---..,.. - ---- � ------ --------- - .. -- -- --- ---------- - ------------ {Title) 9 (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY T' ©'.- DATE...... APPLICATION ACCEPTED BY -z� T��'� `-------------- - ----- DATE I�. REVIEWED BY----------------------------------------- -------------------------------------- DATE------ ---------------- --------------------=---------------- BUILDINGPERMIT ISSUED-----•------------------------------------------------------------------- I Alterations and/or recommendations-------- - -------- ---------- ---------------------------------------------------- ----- -- 1---4------------- - - I ---------- ------------ ------- IY ---- U A Tho T 1- s1.�w --. ------ ------ --- ,N ----- , sP �' 5 1 - 1 1 - �� FINAL INSPEC Date_- __ -- r SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 205 West 9th Street 1601 E.Hazelton Ave. $ 340 West Oak Street. y rt �r Lodi,California Manteca,California Tracy,California Stockton,CaliFornia Ip` I F.P.CO. .l .i