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FOR OFFICE USE: ---------------------------------- ��.__•. -.�,„,.y,______--„�, ,APPLICATION, FORySANIT�ATION PERMIT Permit No. c2.C�',ZZ ----------:----------------------------. ------ {Complete in Duplicate) 6 ---.---_-;_________------------------------------------- t This Permit Ex fres 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 Ordina- e f'No. 54!'.V'-! i JOB ADDRESS AND LOCATION` / �-- = � 76`aK- --`------- f-"-"'--__-__ ----'---- 1 Owner's Name----441 d - * ----- - CC..r -- -�L Phone. Address !� � � .t` 1�/.....---------------------------------------------------------- ------ #� C - Contractor's Nam y------.:- - ,` ------- " ~_l- .#- ------------------------------------------ Phone--4!� installation will serve: Residence Apartment House ❑ Commercials❑ "Traile Cour"tt❑�'Ivlotel [] Other ❑ ! Number of living units: -� Numbrer o> .edrooms _�% _,Number,of baths J----- Lot size - --- ---- - - ----------- ------------ - Water Supply: Public system % Community system`~❑ Private Depth"#ogWater-Table -------- ft. l� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑- Adobe)' Hardpan ❑ Pirevious Application Made: (If yes,dgte----- -------------] No _ New Construction: Yes ElNo [%--FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available'within 200 feet.) M f Septic Tank: Distance from nearest well-----------------Distal from foundation-------------------.Material-------- _ --------------------------- ---.-_-. ❑9a$, 6 No. of co mpartments---------- ----f ----- Size-----�----------------------------Liquid depth--------"��....��Capacity--------------�........ 4� Disposal Field: Distance from nearest well.N`V-�Dist ance from foundation---/Q--------.Distance to nearest lot line--&T-t--- Number of lines----2,-- ..-.�,I.--j---.-.--_Lengfhl'of each line-----4--- -----_--- Width of trench----2.4-f/ T e of filt#er material--•� 5 1- ' th Iof filter material------1--g-.------Total length-------4-p-------------------------- Seepage i -°' ` ' p Seepage Pit: Distance to.nearestswell.,I)W.6 E,)istan b from foundation--- 11e to nearest lot line_ ----- Number of pits--- Lining material-- -G-----Size: Diameter---3-a----.-.--.Depth--. �-�.�•�.,.....�«.,.n.r . ' -- - - -------------------- Cesspool: ---------------- Cess ool: D7istyance fom nearest well----------------- m erial- - - ---------- -- - -------- I --- --I ❑ Size: Diameter---------------------------------- ---Depth------- --------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buJding.---------------------_----_-------------. t r� ❑ Distance to nearest lot line- -----•----------------------------------------------------------------------------------------------------------------------- ------------ Remodeling and/or repairing (describe):- ------- ---- -- ---•--b-- -- •-- ----•-------------------------------------------------------- --------------------------- ------ ------- ---- ----- -- �--- -- -- -- - --------------- ----------- L> ------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------ -------- I hereby certify tha have prepared this application and that the work will be done in accordance with San Joaquin County "~ ordinances, State laws, and rules and reg tions of the San Joaquin Local Health District. (Signed) ------ -- ------ ---- +r--�-t--- z - -- -- ----�-------- -------------------------- (Owner and/or Contractor) � By:------------------------- '-t 1. ----- {Title)----- 3 (I'le+ Alin, showing size of •+, location of system in relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ - ------ DATE------ G --- --------------------- REVIEWEDBY--------------------------------------------- --------------------- ---------------------------------------------------- -DATE PERMITISSUED-------------------------------------- - �` � DATE------------------------------------------------------------- Alterations and/or recommendations:----------�' Y-�; �� ' ------------------------------------ --------------------------- ------------------------------------------------------------------------- --- -----------------------------------------------------------------------------------•-------•--------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - ---------- ------ - - - --- - - --- -- --------------------- e ----- FINAL INSPECTION BY:...... i - v------------------- Date. 7�1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.