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I sV QR OFFICE USE: \ ",f �l--------------------------------------- C),g. .. ---- AFPLICA-TIONN,FOR SANITATION PERM�'f Permit No. __- _!K ----------------- [Complete;Cn Qulalate} This Permit Expires 1 Year From Date Issued Date Issued S_ �r I s Applidation 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 549. r ---- Add _ o JOB ADDRESS AN OCATION -- --- - Phone - � r t Owne 's Name --- -- --- --- Address._4? ......4.----i4E��T1,6/I----�- 5��em-Av----- �---------------------- Contractor's Name --------------- -qham- � � - --------A-------5-0 N.e ---------------------------------------- Phoned_&f &77------ Installation will serve: Residence [] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ®tom Q q ---''Number of bedrooms -------- Number of baths -------- Lot size --------------------------------------------------__--.--.- �i Number of living units: ---- � 4 � Water Supply: Public system ❑ llCommuriity system Private Depth to Water Table 7 ft. Char ter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe x Hardpan ❑ Previous Application Made: (If yes,ddte--- --------) No K New Construction: Yes K No ❑ FHA/VA: Yes ❑ No J� TYPE iOF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f r `� Septic Tank: Distance from 'inearest weir ..--Distance from foundation-_ lv_-----.--.Materll_: _ rrr!.--.--- No. of compartments__ ___________________Size-! _X. ---_--- --_Liquid depth.--. Z.-....-..-----.Capacity3io Number of line ` r �I Disposal Field: Distance from nearest well. -Distance from foundation--3---_-...__-Distance to nearest lot line-------�_- - Length of each line_ __ t f s--�-�--- ----- - ,llQ�- ----- Width of trench� --.-�1------------- �� Type of filter material-- -------Depth of filter material---- Z B otal length ae Pst: Distance to nearest well-.Q-0..-------DistanceA�omundation---P g �a' .Distance to nearest lot line---�--.-.__..Number of pits___._.___-.----Lining material__ ....Size: Diameter____ _-_- ...-__bepth-. _ ------ Number of pits--------4------------Lining material__'------- ------ ....Size: Diameter Cesspool: Distance from Iinearest well-----------------Distance from foundation....--- ---- Lining•'ma{erial��_--....____'_=__---______----. Size: Diameter'-- - ------------------------------=Depth----------------- --- -----Liquid Ca acit-. _ gals. Privy:p Distance from nearest well-------------------------------------------------Distance from nearest building---...---.-.---------------_~:':--------- Distance to nearest lot line--------- --------- ----------------------------------------------------------------------------- --- ---- -------- -- - ----- Remodeling and/or repairing (describe)------- -- ---- - - ------••----• ' '' riR - ------------ --------------------- -------- I � , ---------M----------------------------------------------------------------------------------------------- ------------------------------------------------- --------------------------------- ------------------------ thereby certify that I have p� ed this application and that the wo will be done in accordance with Sart Joaquin County ordinances, State laws, and rules nd r gulatians oft San Joaquin L Health District. o (Signed) 'l - --- ----- ---- -- (Owner and/or Contractor) I; By:------------------- ------ ,4--r------- ----- - - ----- - -- - --------------- (Title) --------- 0 plan, showing size of lot, locaition of system in relat n fo wells, buildings, etc., can be place on reverse side). + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----:,I f ------------------------------------=---- DATE-------�-_ ------------------------- REVIEWEDBY-------------------------------- 'I------ ------------------------------------- ---------------------------- ----------------- DATE-------------------•-------------- BUILDINGPERMIT ISSUED----------'I ----------------- ----------------------------------------------------------------- DATE--------- --------------------- -------------_--------------- Altera'fions and/or recommendations:--.--J-V9___ /' - ...-- /, ——----- r ........ -rs ----- --- I�-------------------------------- ----- ------------- ---------------------------------------------------------------------------- I it I�-------------------------- fl ------------------------------------------------------ j !3 F1NAL INSPECTION BY:. ' -'-�--------------------- ---- - - --- a e----- -. --------------------------------- SAN.JOAQUIN LOCAL HEALTH DISTRICT I I 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1, Stockton,California Lodi,California Manteca,California Tracy,California r.R"c o. �� i6