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FOR O''-FIC E SE: .................. ....... ......... . ..I........- APPLICAI�,.,N FOR SANITATION PERMIT Permit No. ... !Complete in Duplicate) Data Issued ...1.�-.f fia-� I ................. -_... ..... .... .1. 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 Jescrbed. T hic application is made in compliance with County Ordinance No, 549. JOBADDRESS AND rLOCATION.........1.: .2_3........... .................................................•--....•............-o•--..�......... Owner's Name..........i.4ti CrcA ..... �r f�c t_......t� t.1! P-...... ......... -. .-...... Phone.l.�.A.. ...... .....1..... Address....................C... Gsrxr ).................................................... .... ..............................---.._........................................... Contractor's Name---.. 0.....1 � l! .j#,JG - cr...................... Phone... ........jCk �I<_ . ........ ...... -� Installation will serve: Residence 0' Apartment House Q Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Plw,oer of living units: _I... Number of bedrooms ...e... Number of baths _.1.._ Lot size ..k`L.._�....�.f�r"'Z.......................... Water Supply: Public system ❑ Community system ❑ Private 2' Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam a Clay ❑ Adobe[R" Hardpan❑ Previous Application Made: (If yes,date. . .. . .. .. .. ) No 0. New Construction: Yes EEr' No ❑ FHA/VA: Yes ❑ No B TYPE OF INSIALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest welL...1J.�.'....Distance from foundation.--...)...........Material_.....C.t4't'tfis. .............-...... .Z-:.. . .....Size..�..X-5....L�...�_'..Liquid dep h........ ..L.........Capac;ty--�Q0 �� f� No. of c:ompartments.......` Disposal Field: Distance from nearest well.. _Distance from foundation.....;=�,c,..'......Distance to nearest lot line......zf�.. Number of lines........_..1......... ....rr... Length of each line......_..�1C�.�._.......Width of trench............__..w1.. V1r! Type of filter material.....�.Crf-f�ti...Depth of filter material.......1.f3 *......Total length......................g.0..`........... t Seepage Pit: Distern:e to nearest well...j.d.P.. .......Distance from f('undat;on....)..I.O•......Distance to nearest lot line....-Z.b..... Number of pits......I...............Lin;ng material. c.. .Size: Diameter..... 3 .......Depth-._--------a-S......- Cesspool: Distance from nearest well.................Distance from foundation......-..........Lining material..__._.-------------------------- ❑ Size: Diameter.........................._. .... . Depth._....._...__.._......_....._. ............ Liquid Ca,-,acity...----.----.---------.----gals. Privy: Distance from nearest well..........................................._Distance from nearest building......-............_...------.. ..._. . ❑ Distance to nearest lot line......... .... ....... . .. ..... .. .........•.--------..............---....._...................._.._.........-- ..... Remodeling ar.d/or repairing (describe):... -1 ,_�5+44 ......ctrl=t —...... �-� K-� _...C......"'.. e.<r..' ....�G►.x C•�r. ................... ...................... ...................................................... ..........................................•...............----..............................----...........................••...........•............_ .......................................... ............... .. 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. jj\\ s .... .1 — .1�`r.. ., �_... ,_....... .......I.........(Owner and/or Contractor) (Signed)......... �^ ! � - B � •• t.. L.,, . ..-..':• .-..._....... . . ............. ............... .....(Title)......... y:. ........+1 a (Plot plan, showing size of lot, location"" system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTM VT USE ONLY APPLICATION ACCE .........� �. / ........._. DATE.1... .. ..0 ,� _..-..... l REVIEWED BY.......... ........ ... /. T DATL ............... i BUILDING PERMIT ISSUED....... .. .. . . ... _. . DA•TE. Alterations end/or recommendations:.. .-.... .- .......... ...........................----__..-. ........... ..... ............. . . . .............. ... ......_...... _......... . _- . ... ......I....... ......................................... -. . ... . . .. . . . . .. .. . . . ca. ....... ... _ _..... . ��j� ter. FINAL INSPECTION BYDate .. ✓. :.��'�'� a��.�. ..... SAN JOAQUIN LOCAL HEALTH DISTRICT t. 1601 E.Nato:ton Ave. 700 Wed Oak Strut 124 Syaarnore Street 205 Wort 91h Srraot stock]..,California Lodi,California Mo.tow,California T:acy,California CG 9 aCviGCD 8-59 31- 7-'63 r v.co