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FOR OFFICE USE: ------------- A` -0LICATION FOR SANITATION PERMT Permit No. ----------------- ------ - --- ----------------- (Complefe•in Duplicate) Date Issued /�> Data Issued --- ------ - ----- -- -- --------------- - ----'------ - This Permit Expiresfes"' 1 Year From 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 1n compliance with County Ordinance No. 549. �-zv,� V,9 ILS-fi7sd�/e >�arnPs ��/0 JOB ADDRESS AND LOCATION------- + '_a-r 9 r ` J,4yl — -,�t----------------------------------------- Owner's Name_ !/� i.t 17a7� �t�L� C ---- ----- . Phone----•------------------------------- Address........ --' p Contractor's Name_ 1 .�,4��-_/"i,9_f71.- .�._-I i4---- Installation will serve: Residence ❑ Apayfinent House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of livingunits: _�_.. NumberU bedrooms 12n_ Number of baths Lot size ----- --- ------- -------- ------ - Wafer Supply: Public system ❑ Community system [] Private)< Depth to.Water Table ------ - ft Character of soil to a depth of 3 feet- Sand Ej Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay [] AdobeX Hardpan ❑ Previous Application Made: (If yes,date_------ 1 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.) /J Septic Tank: Distance from neo es} well__+.:__._____.Dis#enc m foundation__--IfJ.�__.....MaterialC..�X _ �- J No. of compartments--.;2 .................size_�.K�2 (z 91 Liquid depth-_.,-�..... ....... Capacity-----�_440p'D_gx& Disposal Field: Distance from neare}�t well -----Distance from foundation._.. _.._...Distance to nearest lot line....... Number of lines_____l�j-------.---_--.-- ....Length of each line-- -I�.`�Q__`___----Width of trench-_._.. �'_................ J _ •-.__-Depth of filter material____1_9_1.1_._____.Total length_-_-.--__-_-_----S_'�Q--r'---- Type of filter material ic.�� Seepage Pit: Distance to nearwell----------- 2..Q.-----------Distance from foundation_-_- .. .....Distance to nearest lot line--.-_ Number of pits-1..............Lining material-- ___.-. Size: Diameter_--.,5!1-.---- Dept h------ ------- Cesspool: Distance from nearest well ----------------Distance from foundation... -...__----- ..Lining material----....--..-_.---.----.---_-_______ 611� ❑ Size: Diameter- -- --------- ----- ----Depth------------- ---------- -------------------------- Liquid Capacity------------------- -------gals. Privy- Distance from nearest well....................------------------ ----------Distance from nearest building-_---_.________-----_-------------_----. ❑ Distance to nearest lot line-------- ---------------- Remodeling --------------Remodeling and/or repairing (clescribe)_ ___ ---------- -__ rl `c7 ---- -ll. �- �---. �e�rl ----------------------------- ----------------------------------- - -------------------------------------- �G- �� . vs--- �_r- --------------------------------------------------------- --------------------------------------------------------------------------------- ----------------------------------- k will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--4 �_4e. y Contractor) _ t, � . By:------------------------------------------- ------------------------- _ {Title)----- ---- -- --- -------- _.------ -s�-dpi.-�- - - (Plot plan, showing size of lot, location of system in rel on to wells, buil gs, etc., can be placed on reverse side). 51 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._. _ -- -- -- --- -------------- DATE.._-1__��__ ._~_�'�. --------------___-- REVIEWEDBY------------------------- ---------------------------- -------------------------------------- ------ ----------------------- DATE--------------- -- BUILDING PERMIT ISSUED------ DATE Alterations and/or recommendations- - --- ------------------- ---------- ------------ ----------- -------------------------------•------------••----------------- ------- ----------- ------- FINAL INSPECTION BY: SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 265 West 91h Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press