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` u FOR OFFICE USE: --- -------------------------------- ,°, `/ ,,,IkPPLICATION FOR SANITATION PERMIT Permit No. .. :�.7`_° -------------------- . --------------------------------------------------------- 1r'_ (Complete in Duplicate) Date Issued --------------------------__-------_----------- V� This Permit Expires 1 Year From Date Issuedi Application is hereby made to the Sbn'.Joaquin Local Health District for a permit to construct and install the work herein described. This application is made i compliance,with County Ordinance No. 549. QjV'c 25"~Z20 02 JOS ADDRESS AND LOCATION ® ---CA_R_R a-kTQI�---------..�- _1[z- ars- :_, - ' � ' t✓ 6 >� - rr /� �d ' �. ( Owner's Name--------------- -- -------- -•-_ -. Ll--t�1--�5-�-----°'------------- - _ P}i'one.--------•-••-------------------•--• Address--------------- �Y " '"- -------;7�------ X11Q, •-•------I--------------••----•----•---------------------------------.----._.. Contractor's Name---5;;ARGliF._4 ---•-------------------- ------------------------------------------ - ---------------- Phone-----_--------•--_ ------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _. __ Number of bedrooms Number of baths/------ Lot size AcKc - __--_____________________ Water Supply: Public system ❑� Community system ❑ Private Depth to Water Table-9-6 ft. Character of soil to a depth of 3lfee. Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E1.1 Adobe ❑ Hardpan ❑ Previous Application Made: {lf yeOclate--------------------I No jq--'lq'ew Construction: Yes jjj_-M6 ❑ FHA/VA: Yes ❑ No-+E}— ,--,- - -TYPE OF,INSTALLATION AND 'SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance fromi wrest well___ ______Distance from foundation--------------------Material---------------------------- p No. of com artments--------------------- ... -------------------------------- quid depth...........- -------Capacity------ -- ---- �q ..r �� - Dis�sal:Field: _D.istance from �earest well, �IQ.Q_D stance from foundation,____!_..._.--..Distance tb:nearest lotline----5 it T 7 Number of lme'5 ="'` _-__.___Length of each lino_______ Q___/r____-Width of trench______. _ 79 f e of filter material__. ,_ Depth of filter material-N. Total len thi______________-;_� .___--___- .� Type -•- -- P ,- - �----- - g -- . 11i ` - Seepage Pit: Distance to nearest well_--?V O\Distance from foundation._-! ____ .Distance#o;nearest lot line__5.--_ ..T.---� K ®f Number of pits-------/-------------LiningmateriY I QC - - Size: Diamei-6r3 lV _.bepth----- 7 _--------------- Cesspool: ---------- -Cesspool: Distance from nearest well------------------Distancem fr foundation_-_----------______.Lining mate ial ----------------------------- Size: Diameter--=------------------------------ ----------------------------- --- -Li uid Ca a /Depth citgals. 0 Privy: Distance from nearest weft_...__ _--------------_----------------------Distance from nearest buildin ------------------------------------------ 4- El M16Distance to•,nearest lot line+/-------------------------------- ---------------------- XA Remodeling and/or repairing (describe)------------------------------------------------------ - - t --------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------- --------------------------------------- - ------------------ --------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with. San Joaquin County j ordinances, St vvs, rules and re ations of the San Joaquin Local Health District. {Signed} --- -- -- -- - --------------- ------------------ ------------ ------ ------ -------(Owner and/or Contractor} L (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-------L--r--R-10-------------- ----------- --------------------------------------- -------------- REVIEWEDBY-----------------------------•--------------- ---------------------------------=-------------------------------------------- DATE----------------------------------------------------------- BUILDING,PEJRM IT.ISSUED----------------------------------------------------- -------- DATE------------------------------- --------------•------------- Alterations and/or re"commendations:."'_"_ n?'". J :[3-��'"' :i _ E:.--� �-u4:.�—_!n/`�Pf.�/�_____..,- -----------------------u►� ..... x... :a_ , - -----Fi-R 3.....gin P on� 1zo. i3 S .- ---. ►r;w .-, .- -- . -r,•-- `-T—fR..o---------- -------------------------------------------------------- --- -- -------------- ----- -- ----- ---- ------- ----------------------- ------------------------------------------------------------------------------- f ---------------------------- FINAL INSPECTION - -_--- - ._-- ___ ---- Date------. .. -_ �6..._ _ . . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California