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FOR OFFICE USE: ---------------- - ----------------------- ------------- "- ------ APPLICATIONO. -SANITATION PERMIT Permit No. J----------- ------------- --------------------- ------------ ------- (Complete in Duplicate) Date Issued ------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Distr ct for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549.f JOB ADDRESS AND LOCATION-----------1h�0 --- - ----_ - .../2Q------O�Z -------------------------------------------------------------------------- Owner's Name------------4Z_.<.. ....��r�-l?�� ----------•------------- ----------------- -- --------------------------------- Phone*O—'/ ---••--- Address.-•-------------------Z.4! 'f ./S`G� !,r. �Y✓�G • ----- Contractor's Name-----.sem-� •---- Phone Installation will serve: Residence �partment House ❑ Co imercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms N tuber of baths .2.__ Lot size -_ 7A62-X-c3/% ------------------------- J 4 Water Supply: Public system ❑ Community system ❑ Priva e [a-1 5epth to Water Table � �_ ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[r-lardpan ❑ [��, ` Previous Application Made: (If yes,date--------------------) No ED-`-New Construction: Yes L-9, ❑ FHA/VA: Yes ❑ No-L — TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is av ilable within 200 feet.) C Septic TaDistance from nearest well__ Distance from foundation_/l1_�_------.Material--�1 <�'�T®�---------- - - l No. of compartments--------'fir--------- Size-------- --------------•---•---Liquid de th---- ------------------Capacity /x�l.� -------- Disposal Field: Distance from nearest well__` .f--Distance from foundation._/49/---------Distance to nearest lot line____-----_. L7 / Len th each line_---- �`�-------------------Width of trench.-----1 '�--------------_-- Number of lines--------- � � g Type of filter material�4�- Depth ol filter material.....1141---------Total length-------AulU_'______________________ Seepage Pit: Distance to nearest Distance frWfun.ation---_/0-/-.____.Distance to nearest lot line--_S�Number of pits--_-_ -_-.----.--Lining materiaSize: Diameter ......Depth---------- 7X Cesspool: Distance from nearest well-----------------Distanc from foundation---------- -_----.Lining material--..---_-------..---..__-.---_.--_ ❑ Size.: Diameter------- --------=----------- -------Depth---- ---- ----------------------- ------------------Liquid Capacity------------------------- -gals. Privy: Distance from nearest well------------------------------- ----------------Distance from nearest building----------------------------------------- ElDistance to nearest lot line- ------ --------- --- -----------------------------------------•----- -------------------------------------------------------------------- CVI - Remodeling and/or repairing (describe}------------------ t ---------------------------------------------------- --------------------------------------------------------- ------------------------------------- ---- ---------------------------------------------•------------------- ---------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and t1lat the work will be done in accordance with San Joaquin County a s, and rul and regulations of the San Joaquin Local Health District. ordinances, 5ta F(Signed) ------------ ------ ------------------------------------------------------------- -(Owner and/or Contractor) -------------- Title (Plot plan, showing size of lot, location of system in relation to w flis, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY = " - DATE------- '- -1'---7-------------==�-------- REVIEWEDBY------------------------------------------------------------------ - ----------------------------------- DATE--------------------•--•------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------- _---------------------------------- DATE.----- ------------------------------------------------------ v^ Alterations and/or recommendations:-------------------------------------------- --------------------------- ---•-•------------_---------------------------------•----- ----------------------- ---------------------- •--------- --------- .- --- --------- .� -: F]NAL INSPECTION B - ---- '--,'., Date__ ._. �----------------- ---------------------------- -- 3/rZ q� �� Qr10?ec }res SAN JOAQUIN LO AL HEALTH DISTRICT C vP4 �""� Gr ea/'� 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.