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FOR OFFICE USE: I ------ -- -------------------- --- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. .6,1 --- ----------------- ----- ----- ------------------- - (Complete in--Duplicate) --- - This Permit Expires 1Year From Date Issued 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. (_g, JOB ADDRESS AND LOCATI N _ (�C -- f� Owner's Name-___-.___ ------- -------- ------------------------- Phone------------------------ Address ----------------------%er Addressto ------------ ,L` Contractor's Name---------- -- -- - ----�-- --� ------------------------------------ Phone------------------------------------ Installation will serve: Residence [�partment House ❑ Commercial [—ITrailerCourt ❑ Motel ❑ Other ❑ '' Number of living ._ Lot size units: _ ___.. Number of bedrooms _ Number of baths r % ---------------- t - _ �f. _. Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table/).11 ft. Character of soil to a depth of 3 feet: Sand 'ravel ❑ Sandy Loam E❑ Clay Loam ❑. Clay [] ,Adobe❑ --Hardpan-E) Previous Application'Made: [If yes,date-----------------_._) No Ra' New Construction: Yes ❑ No j9' FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank:, Distance from nearest well-----------------Distance from foundation--------------------Material ___.-._______.._____.-___._._______.__________.. r ` Y 5104 No. of compartments...----------------------.Size------ -----------------------.-Liuid de th--------------------------Capacity Disposal Field: Distance from nearest well-- .:_e--. Distance from foundation..�_�----_.._Distance to nearest lot line_�0 Number of fines_____ _f ___._+yLep Length of each line_ - g 'r--------------------- g ------------Width of trench.- ; Type of filter material . De th of filter material....��-__,- - -----Total length _ to Selaen+crest well_=.-: Distance from foundation Distance to nearest lot line Number of A __Liningmaterial Size: Diameter __ Dp - '--..-_-.-_-_-_-_-.-_- Cesspool: Distance from nearest well-----------------Distance from foundation------------__.-_...Lining material..___--------------------_----------- 1 � El Size: Diameter------- ------------------------------Depth--------------------- ---------------------------.Liquid Capacity----------------------- gals.- Privy: Distance from nearest well-------.---------------------------.-------------Distance from nearest building.._-------__._.____-- --__-..__----. . t ❑ Distance to nearest lot line-------------------------------- ---------------------------------------------------------------------------- -------------- Remodeling and/or repairing (describe):---------------- ��----.- / ; -___--__--- - ------- / ---•----------------------•----------------------------------------------------------------------------------------------------------------------------------- --------- ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------•------------------------- ---------------------- -- ----=------------ 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. /r (Signed) � h'�.: E�1_ - ---------- --------------------- ----------`- or Contractor) BY: --•--------------------------- -------- 1 ----- Title ' /�- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY =F =®--------------------------------------------------------------------- DATE------ l r� � = REVIEWEDBY------------------------- --------------- - - --------------------------------------------------- -------•-------------------- DATE S_X�T-�WJ --------------------------------- BUILDING PERMIT ISSUED._ .-----�-L3D�7 --------ir__-�Rr�'__----0�-'--------- DATE------ 'i Alterations and/or recomntendations:__..__� -___ _F..L/lIP -__S�4111� //yF'147`"- -71O�____!��______:� C x-%---------------- --`-`-.----D.�iA.W_j7)_s- ------- �7 F Yt s `{^� A r .r_n� 1 �R `f #+ 7 ------W-44-------- - 1f Pa _,..F R [ i n}f F -•------------------------------------------------------------------------------------------------------------------- r :i ; FINAL iNSPECTI •- - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California w Manteca,California Tracy,California F.P.CO: ii t