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--p------------------- 3; 3° zy .a IN APPLICATI011e FOI�i SANITATION PERMIT Permit No: -------------- ------------------ ------ ---- (Complete in Duplicate) Date Issued i ....... --N - - This Permit Expires 1 Year From Date Issued Application is hereby made-:to the San Joaquin Local Health District for a permit/f,construct and install the work her in described. This application is made in compliance with County Ordinance No. _9 105'tJ ` l �i�ri?�) r JOB ADDRESS AND LOCATION Y 0/_/�'� f2l� ,F� i(/E . �•y� / --- ---- -- -- -- ---------� ----------------------------- ------ Phone---------------------•---------•---- Owner's Name �q --- 1�< 7--• -----a� _ Address - -------------------- Contractor's Name-------- -- -- ---- - ---•- ------ - Phone '= Installation will serve: Res once ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 2�—' h� f Number of living units: _.- Number of bedrooms _ Number of baths --- _- Lot size _4914?Le- M ' Water Supply: Public sys�i m ❑ Community system Private ❑ Depth to Water Table ally 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 [Z?' New Construction: Yes �No E] FHA/VA: Yes E] No �---Q, TYPE OF INSTALLATIONIIAND SPECIFICATIONS: �!} (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /- _. Septic Tank: Distance from nearest well- __._Distance from foundation_ 1Mat�iaJ l��l ---- ---'---- --- [� No. ofcompartments-�„?"_:.__�__-___..Size �__JX4-�iquid depth___ --------------CapacityX f�_.-.- t Disposal Field: Distance from nearest well-IP19-_-Distance from foundation,�a�,.------Distance to nearest lot line--4-__---- / Numbelrl� of lines------- ; • g A � -- Length of each lin ��-- _, .fN dth of trench_v _____________________________ Type of filter material A .Depth of filter material.. .----.Total length-.�aw- ----------------------- JI Seepage Pit: Distance to nearest well---1.r`_a------Distance - from fojndation.��--___._--pista�e to nearest lot 1ne_� ...... De th_.Numb3 of pits....---- -Lining material --Size: Diamete -------------------- qIl - ?� Cesspool: Distancie from nearest well-----------------Distance from foundation-------------- Lining material--------------------------.----------. d [] Size: D`liiameter-------- -----------------------------Depth_ -------------------------------------- ----.-Liquid Capacity-------------- -------gals. Privy: Distanlly`�e from nearest well ________________________________________________Distance from nearest building.._.'_---______--_---------------.------ ❑ Distance to nearest lot line ---------- -- Remodeling and/or repairing (describe):-----_- __ ,---_ __ G __ �5' ---- •r° �li } --------- ------- ------------ !M' --------- ------ ------------------------------------------ ----------- -------------- ---------- ,i --- -- - - --- -� ---------------------------------------------------------- ---- 1� ------------------------------------------------------------------------------------------------------------------------------------ ---------- - I hereby certify that Ilhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation of the San Joaquin Local Health District. f (Signed)--------------------------------i----------------- �or Contractor) By:--------------- all -•------------------------Irel ' - s (Title)_,,. ------------ - --------------- (Plot plan, showing size of lot, location of system io wells, buildings, etc., can be placed on reverse side). 4h FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. DATE_______--",3-`- ----------------------------- ----------- ------------------------------------------------------------------ REVIEWEDBY----------------------�!'----------- - --------- ---------------------- -------------------------- DATE BUILDINGPERMIT ISSUE6--------------- -------------------------------------------------- ---------------------------------- DATE----------------------------------- ------------------------- Alteraflons and/or recommendations------------------- ---------------------------------------------------------------------•---------------------------------1-ja_SII -- - - -- -`- .- -- tg, A-' .- - r - -------------- --- - ------------- ----------------- l�N' - --------------------- -------------- ---------------------------------------------------- ---------------------------------- ----- - ---------- -------------------•--- - I FINAL INSPECTION BY:. _--'.�I '�- .. --------------- Date----------- _�_ - -...-' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatelton Avr: 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California'i Lodi,California Manteca,California Tracy,California i