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}OR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No, (Complete-in Duplicate) This Permit Expires 1 Year From Date Issued ! "'' Date Issued .......-1T�d Application is hereby made to the San Joaquin Local Health District for a permit to construct endLinstall the work heroin described. This application is made in compliance with County Ordinance No. 549. / Nex-1f `T qj'//,101 Ad JOB ADDRESS A D LOCATION........ ..7`. ..... .,c:I�i. �''.�f.�.lL:l� �.'.<...+..� 3[:...:...�, F`�o"?'�e�'t'd) �f ,r-. Owner's Name.... C�Di2Fr- ... .�'.n./�/ Address.............: .9.. .:. ..&...................,...... ............... ....... .................. ........................—................ ..... Contractor's Named .. ... '.�a(/,.1.k1 ...,f (�h ...�a. ./.....�J<'.C............ .. ......................................... Phone.......... ...: _........... Installation will serve: Residence�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ../... Number of bedrooms—). Number of baths ...I.. Lot size ....Y. A9.< ,�5.... Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Tabls4t?. ft Character of soil to a depth of 3 feet- Send ❑ Gravel ❑ Sandy lobm❑ Clay Loam❑ Clay❑ Adobeld Hardpan❑ Previous Application Made: (If yes,dote.. ) No ❑ New Construction: Yes ❑ No* FHA/VAI Yes❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Dist nce from foundation .—. ......Materiel ,........ ... .......................... No. of compartments.. "'" S ®'Te �.� Distance from nearest well ' Distance nt� �^ w liquid depth:.. ..... .: '. Capacity.................... Dlsposgl Field: Distance from nearest well /,S C, .Distance from foondati n...,�—..t:.'....Distance to nearest lot line....... Number of lines.... Length th of each line.. .. ..fi'....... ......Width of trench. '�..+.... ..... .-... —� p d Cj Type of filter materia in, ..Depth of filter materia.. _...Total length.................... . Q ' �'�1 See age fit: Distance to nearest well 1-0........Distance from foundation...`T`'.C.'...Distance to nearest lot line..... . fs7'/? Number of pits ............ . Lining material.-IROC.<<,- Size: Diameter. �►�� . Depth . N�.'.............. -1kCesspoo: Distance from nearest well—.... ..Distance from foundation Lining materiel..... .............................. ❑ Size: Diameter. .. . . . . . . _ Depth. ... .. . . -... — . _. .... Liquid Capacity. . .....................gels. \\J Privy: Distance from nearest well Distance from nearest building..................................... ... . ❑ Distance to nearest lot line _ ... . .............................. .._............ ...............I.......................... Remodeling end/or repairing (describe): (7 7 �. .......................... ................................. .........: -... � {��-.1�I.0 I..Ia. y is::.: /:.::'.................... .. ... ... ....... _..................................................................................... ... ... ........................................................ . 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, (Signed)......... _.. ... ... ... . _. . . . . (Owner and/or Contractor) By:..... .... .._ .... ......_. ........ . .... ... _. . .....(Title).. . (Plot plan, showing sills of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By./�-' DATE.�, ' ,Y. .- ....c... . - ........ ................. REVIEWEDBY .. .. ..................... ..... DATE.... ....... .............................................. BUILDINGPERMIT ISSUED __ ...... ......... ................. . ... .......... DATE.. . ........... ......... .. .. ......................... Alterations and/or recommendations: ........ ................................................. —................................ _ .......... . .. ... .. .. ........... ...... .......... .. .. .... I ...........I.... ....... FINAL INSPECTICtj BY: SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 !.Narehon Ave. 300 West Oak street 124 Sycamore Street 203 West Vth street Stockton California Lodi California Manteca,California Tracy,California [M 9:M 1 67 V—wo•tl c..,s