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F0j, OR 10E USE: ----------------- - ------------------------ APPLICATION FOR,,SANITATION PERMIT Permit No. . Y- (Com�.pl.te•an Duplicate) Date Issued /D �_ �-- - . J ----------------- - This Permit Expires l Year From Date Issued App lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----61 aY ✓_ ANAL-----�)" D l---r-kfile.Y------------------------ Owner's Name--------------jQH-t0.--•t--.___ )gLAA'0---------•--------•----------- t2 } --- --------------- -------------------------------Phone --------•------_---------••------------ Address x r� Contractor's Name................. • - ---•---- ----------�----�-- one..�sJ.rS._"'" ' -...!_------ � Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Lot size . 43,54.Q_504-----------•-------- F Number of living units: ...__. Number of bedrooms _3_.. Number of baths - _ Water Supply: Public system ❑ Community system ❑ Private 56 Depth to Water Table 17, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: (if yes,date-----_-----_---_....) No ® New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: r --(No septic *ank-or cesspool-permitte d:if,public sewer-is available.within 200 feet.]-- Septic Tank: Distance from nearest well...._9tY_____Disfance from foundation __--1-0--------- 4_ . --- Material-----' ---------a�� ----------------- Septic �aQ-: No. of compartments..-____-- .- -- �-!4 ` Size -1� `� - Liquid depth --4 P Y `� cc Disposal Field: Distance from nearest well-_ 0�..._...Distance from foundation..l�.�._...._._--Distance to nearest lot hne. ./. ------- 0- ----------------With of french..__.19.7---------------------- Number -- -- Number of line ------------ - Length of each line. _$ ��52 ._.--.. ---Total length----------- --------------- Type of filter material--S.Qp.. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line__..___...-_---- ❑ Number of pits----------------------Lining material----------------------Size: Diameter----------------- ----Depth----- -------------------------- ante from foundation-------------------- material___..._-._...__--------------------- Cesspool: Distance from nearest well.................Dis# Privy: Distance from nearest well ___ ____________ gals- El ` --Liquid Capacity--------------------------•- Saze: Diameter--------------------- ---------------Depth--------------- ------------ ------- ' --" _ ...... ............. _Distance from nearest building I __ _ Distance to nearest lot line--------- --------- -------- -------------------•------------------------------------------- -- ------------ ----:, �. -�-- ..... -----------------•-------------------------- Remodeling and/or repairing {describe}:__...- ----------------------------- ----------------------------------------------------------------------- -------------------------------------- ---- - --- -------- - --•----- - - -- - - --- -------- ----- I hereby certify that 1 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. Si neo - caner an �Co or ( --T--------- -----(O and/or.. �. . _. � : ,_. .. = --"�==-�--- -=------=`-_(Title _�•-•------------------ ---=----- -BYE- - ---- ••------�/_L�-------�- - ---------- - -(Plot-plan, owing'size-of lot location-of-system'in=ralation-to-wells;-buildings;'etc:;-canThe*placed-on--reverse-side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B - - ------------ ---------------------------------------- DATE------ °? ---- �---------- -------------- REVIEWED BY-------------------- -------- ------------ -------------------------------------------------------------------------------- DAT BUILDING PERMIT ISSUED ---------------------------- ---------•------ - ------------------------------ DATE----------------------------- --------- Alterations and/or recommendations--------------------------------------- --- ---------------- -.._._...._............. . . ---------------- ----_--I...... . ' FINAL INSPECTION Date----- --- ---------------------------------------- t JOAQUIN LOCAI`. _EALTH DISTRICT 4 1 bol E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f1 Lodi,California Manteca,California Tracy,California Stockton,California , F.P.0 O. Lc: