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FOR OFFICE USE: _ ......... APPLICATION FOR SANITATION PERMIT Permit No.. .Q � a.. `� (Complete in Duplicate) Date Issued _.S LZ7.-V'6 ....-- ... 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. 549. JOB ADDRESS AND ATION..L /b..... .A..r.... ....... ....... ... .................. Owner's Name..-...-. {}.f .._ . .Q.or:n�..........................._. Address ............ 42: ..Conirector's Name .......... .... ............... t.............. - /. Installation will serve: Residence/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel C] Other ❑ nn nn / Number of living units: N mbar of bedrooms Imo... Number of baths ..Ct. Lot size ..�_ ?�_�.��%_ �............... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .&Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ur'�`Hardpan ❑ Previous Application Made: Ilf yes,dote. . I No ❑ New Construction: Yes ❑ No * FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SrTonf� I Distance from nearest well - _ . Distance from foundation ............. ... Material ._ .._ ........._ ....__......... _.... 1 No. of compartments.. Size ............... ... ....Liquid depth.... Capacity.....................QAD" a�F' Distance from nearest well N DZ1 _iDistance from foundation .............. Distance to nearest lot line..-...... Number of lines ..._�.... ..... .. Length of each line... 0_0 ........... of trench. 2j r._`.__..... rr �� Type of filter materia. 1 ,IJ( Depth of filter mate na...._19-...._Total length ......................Q...� Ser Pit: Distance to nearest well-N0.l1. ., .Distance from fQundation....�.. ...... Distance to nearest lot line._....5.. Number of pits. ... _ ._ Lining material._RCC 5[ . Size: Diameter.,.,,3j '/. Depth__. ,/r's _ Cesspool: Distance from nearest well _ ...........Distance from foundation........ _... Lining material__ ......_........._... ❑ Size: Diameter . __ _ .. _ .. Depth- ._ . _..... .... _... ... ... Liquid Capacity ... -_..... _...............gals. Privy: Distance from nearest well.... _.--- Distance from nearest building _............. W ❑ Distance to nearest lot lino . _.._............ Remodeling and/or repairing (describe):_ .... Qfilt ��'` .. ........................... _ ..... __. - ...__... _..... .._ .__.... ..... .............................................. ... . 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 Soman Joaquin Local Health District. (Signed)...4.G[ tl .�/Ll�'..1.�.. .. .. ..C�` ....._...... ....._ _ jO�oeP�d� Contractor) By:.............................................._......._................ _..-....... t—_. ... Title) . . _ (Plot plan, showing size of lot, location of system in relation wells, buildings, a(_can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._...............__........... ...... ..... ................... DATE....._rf �L%'-. _6_....._................_.... REVIEWEDBY_................ _....__ . :..-....__.. - _.--.........._. DATE__ __..-............. _............................... BUILDINGPERMIT ISSUED ............ . .................... .-......_........................... ......... DATE ................ ........ ................... ............ Alterations and/or reco mendafions _ .f �}• 66. ;,.. �7' _.�.�,ro.f:. �,3. �..�..��..A'��...y. .�irt✓�af. ....Qen� W,— .- ....___.._....._.. .. __... ..... .. ....... ... ............ ................ .................. .............. _...._..... ..... ..................._........ .... _ _...._............... ...... ..................................... .... ......_........ _.......... __................................ _............ .. FINAL INSPECTION BY:... ��..a Date. Y -.20 fj,e _.............._....._.._.._...._.._.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Ifaaatmn Avo. 300 Wait Oak Strom 124 Sy<omon shat 205 Woo 9th Proof S/adNn, California Lodi, California Manteca, California Tracy, Conform. r.P.Co.