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�C7 .� ------------------------- ----------- -a� APPLICATION FOR SANITATION PERMIT Permit Not -�_1 C, 1 ----------------- -------- --------------- "------ ---- (Complete in Duplicate) . ___This Permit Ex ices 1 Year 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. h7111-E WAST o.� F4-Aoo JOB ADDRESS AND LOCATION--E�tSTc2N E JET,$ R p, 7 SAO ------ --- 1 Owner's Name.----------'1-�--'---•--C-�---'----- - -----------•----- -- ---D- -----•----- '-�at<C's?C _ ` --0 -------- -------- Phone - ----- -------- Contractor's Name-------- �--y_--_--}-- 5 e --------------------------------- Installation will serve: Residence ❑ Apartment House p Commercial ❑ Trailer Court ❑ Motel Number of living units: _-.t---- Number of bedrooms _ I_ I t ❑ Other 7'21 +1, 7Z a - --___ Number of baths _----.__ Lot size __.--"_��---✓d C�'L�------------------------ Private _______ Water Supply: Public system ❑ Community system ------ Y Y ❑ Private K Depth to Water Table -0 ft. .� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date...---------.-------) No V New Construction: Yes No ❑ HA/VA: Yes ❑ Noj TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Disfance from nearest well1_e_a' Distance from foundation--.-+p'_ _ - --.----.Material-.2��QQ roti No. of compartments-----------'2—...-_----Size ------------Liquid depth . lz�----------Capacit --_--Uo ----------------- Disposal Field: Distance from nearest well.___iGo!.--- y Distance from foundation.--1o_'_.._.---Distance to nearest lot line--_4-/---.--- m Number of lines-------------I--.-_-.__-_"-.------Length of each line---------Y O-----_. Width of french Type of filter s material_,�1- _{Depth of filter material-------1-{r...-_--...Total length-------------- � Seepage Pit: Distance f nearest wall_-_.-j__U'.__..__,Distance from fo/undation_--_A.Q_{_____..Distance to nearest lot line----- �i 4 f C�c Number of pits.----`;- -----------I inng}mafierial. _a-� IL_.Size: Diameter--------,3�3-'�----Depth-------------2�t- a _.~` tit r,� ' � Cesspool: Distance from nearest welt__.__- t'_ Distance from foundation- __-.._---__.Lining material-__--"-_________________ ❑ Size: Diameter----------------- -- -------------- 'Depth--------- --------------------- --------------------Liquid Capacity. ------- fr Priv j .;t t gals. " Y Distance from nearest wellEl _________________ms,µ-_ _ pistence from nearest buildin �(1 Distance to nearest, lot line----------------------- g.--_-.---. ---------- ......--- --------------------------- -------------------------------------- Remodeling and/or repairing {describe:__---_1-&+,BTW L .�— S �''� ` 2--- --- -- ''�"L -------------- ------------------------------------ ---- -------------------- ----------------------------- ------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------=-------I------------- 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, {Signed)------------- ` - ---- ----------- -------- -------- ----------------------------- + By:. {Ow er and/or Contractor) _ r - - - - - - ------------------------------------------------(Title)---------- (Plot plan, showing size of lot, location of sys em in relation' elation to wells, buildings, etc., can be placed on reverse side). �y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--_-___."_C�..-" --- -- __ ------------------------ ----------- ------------------------------ DATE"- 7_---- tom` REVIEWED BY ---- ---------- --------------------------------- ------------------------------------------ ------ DATE-------------- --------------------- UILDING PERMIT ISSUED---------------• -------- ----- --- - _ _ _ _ _ _ -------------------- Alterations and.or recommendations:--------------- --"- - ------ ----- — -------------------------------- DA•TE------------------------------------------------------------- Jr �! �' --------------------- ------------------------------------------ ------------------------------------ -------------- -------- 1 ------1_-Sr� -_-_".----_.- ----------------------------------------"_------.`___•------- ..-.:'S...--.----.?-- ----------------------- ----.--_ ............ ......... q _ ------_.---`--`----_ a FINAL INSPECTION $Y:- -- ------------------- ---- "----- ---- ------ Dafe �;7—9-"- _..._ SAN JOAQUIN LOCAL HEALTH-DISTRICT 1607 E.Hozelton Ave. 300 West Oak Street Stockton,California Lodi, California 724 Sycamore Street 205 West 9th Street �`•, ,,. e � Manteca, California Tracy,California Py�•p... '- F.P.CC.