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FOR OFFICE USE; ,.. �.,. ..�... . . _. }- -/ � --�5 ----- 1_Q,aa_ - - - -.SZ/_.:.. . _ Permit'No:':�,� - APPL1CATf0'N -FOR"SANITATION PERMIT" _- - ------------------------------------ [Complete in Duplicate} Date Issued 16;2_,15-_4S -------_............: i This Permit Expires 1 Year From 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, son JOB ADDRESS AND LOCATION - - AVS 47 y---------------- ------------------------------------- ti ff - -- ==-- --M- -Owner's Name-------- �°AAL- L) l4 ------- Phon r- 1-1 -------- -------------- --------------- Address �---- -- - -------------- Address--------------------------- ---------__-•--6px-----t4l_ SYoc�- w! .-. ' - t5 .AJ Contractor's Name------------------ _ -- ----SAW-6 __ F'. Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ a Motel [3 Other Q Y Number of living units: -------- Number of bedrooms ________ Number of baths _____-' LotFsize""" ' :'_"=--------------------------------------- r Water Supply: Pub4ic system A Community system ❑ Private ❑ Depth to Wader Table&0-- ft. wti i Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam-❑: .Cl_ay,-.❑ Ad ��obe- Hardpan ❑ Previous Application Made: (If yes,date-__________________) No$-.. New Construction: Ye's ❑?No FHA/VA: Yes C]. __No� w TYPE OF INSTALLATION AND SPECIFICATIONS: x [No septic tank or cesspool permitted if public sewer is available within 200 fee+.);` Septic Tank: Distance from nearest well_________________Distance from foundatio ,_.____,__=p__._.Matefial___""= '-------------------------.-`- ❑6fiteftN6 No. of compartments---------- ---- ----------Size------------------ - - -Liquid de th------------ ----Capacity----------------- --------------- Disposal --------------- E i Disposal Field: Distance from nearest well-----------------Distance from foundation-------.___-='_____.Distance to nearest lot line_______ ______ _ - -.. ❑5v5PAIG Number of lines-----------------------------------Length of each line------ --------------- -----Width of trench------ ----,--=------ ~---- -- Type of filter material_________________________Depth of filter material-______-___-______=._Total length-------_'___ ____-:___________------`- ' II Seepage Pit: Distance to nearest well_-_NfN--��--'___Distance rom undation___�_.____ -y Distance t- _.es l li ----------------- Number _� ___�__:. , �i P Number of pits_."" --__Lining material_ ___ __ __ _________Size: Diamete - - � i Cesspool: Distance from nearest well-----------------Distance from foundation____________________Lining material__.___.---------------------- ❑ Size: Diameter----------------- ----------- ------- Depth---------------------------------- T - Liquid-CapacitY__�^"� F .._---Distance from nearest building Privy: Distance from nearest well ----------------- ------------------------------ 9----------------------------------------- ❑ Distance to nearest lot line------ -------- ------ ----------------------------------------------------------- -------------- -------------- Remodeling and/or repairing (describe):-- - .--- -- �--------- --- ----------•-----------------------••-----------•------------------- - ----------------------------------------------------- t t I hereby certify,that ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd ules and regu tions of the San Jo uin Local Health District. k, (Signed)_ ----- --------- ----------- - -----------� --=---- ; ----------------------- {Owner and/or Contractor] ------------- ---- - -- ------------- By:--------------------------- (Plot - ------------ - [Ti+le� I [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pla d on reverse side]. FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY------- , ----------------------------------------------------- DATE--------- ? J' 'f-'.•, `"""""--------- REVIEWEDBY------------------------- ------- -------------------------------- DATE------.-------0'---•--------------------------------------- BUILDING PERMIT ISSUED---------- ---------- �/ ----- .._ DATE------------------------------------------------------------- -------------- and/or recommendations:-------- fi� �� ----------------------------- Alterations -•---------------------- -------------------------------------------- ---------------------- ----------------------------------------- ---------- ----------------------------------------------------- -----------------------T---------------------------- Ii ---- ------------------------------------------- ----------------------------------------------- FINALINSPECTION BY:----------------J�-------------------------------- -------- Date ---- ------ ....... --------------- -------------- SAN ------- - SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,t6lifornio Manteca,California Tracy, California f