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rUKUVNU: USt: -G ------------ le- - --------- ' -�.--- ------Z_ _ APPLICATION FOR SANITATION P T Permit No. .G2�Dc31?_ (Complete in Duplice+e) i4NNE - - -----'--- . -�0.....-----.. --- -- - -- This Permit Expires I Year From Date Issued to 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. i JOB ADDRESS AND LOCATION...+�X%Z_L ----G_.----..._. . l�k�o --------------------------------------- fOwner's Name_-pZ44- -- - - ------- -- .........' --- ---- - - -- --------------------------- Phone.---------_-------------------... Address------ aQ ---------`--------------------------------------- - - - - - - - - - - - Contractor's Name--__Z�:, ------------T Phone------------------------_...... ... Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms ---1... Number of baths ---1--- Lot size ---,�_O_JL/Qo--__-----_-_-----_-- - Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table _`D- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe En--Flardpan ❑ Previous Application Made: (if yes,date---_._. .-__-----I No Ir New Construction: Yes ❑ No EY]' FHA/VA: Yes ❑ No [?t' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well___ -------_-Distance from foundation------- ------------Material---------------------- -------------------- No. of compartments-----_-------- ----------Size-----------------------------_-Liquid depth-------------- ---------_Capacity. Dispos d: Distance from nearest well-.---------Distance from foundation.-J-9--e-_....._Distance to nearest lot line._ P;W Number ._...._-- of lines--_1__---_--_-..--_.-_-.---_Length of each line_---3Q--__.--.._.,.-_.Wid+h of Type of filter material_..-1�P6�------ Depth of filter material-_ Arr-.______..Total length___,30__ _____________________..- Seepage Pit: Distance to nearest well-__.------_-------Distance from foundation.............._._-.Distance to nearest lot line--.-------------- ❑ Number of pits----------------------Lining material----_---.-------__Size: Diameter---------- Dept h_-._--..._------------------_. Cesspool: Distance from nearest well .-Distance from foundation-_ -------------- Lining material----.--_-_--.--_-_---__---_._.._ ❑ Size: Diameter----_------ -----------------------_Depth----------------------------------_----------------Li uid Ca aci Liquid P h'-------------------- ---.gals. Privy: Distance from nearest well----_----____------------ ___----- _Distance from nearest building_-------- .--------------------_--- -_. ❑ Distance to nearest lot line-. _.-._-__.__.------- Remodeling and/or repairing (describe):-- -- --------- - -------------------------------- ---- ------ ---------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, epd regulations of t e Sen aquin Local Health District. (Signed)------------------------and r s / .-- --------------------------- -(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------ ------------------(rifle)-----------_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------ DATE------_ �}Y� REVIEWEDBY------------------------- ----- -------------- ----- ---------------—-------------------------------------------------------- DATE.----- --------------------- ------- BUILDING PERMIT ISSUED-------------------- - --- - --------- —c -- DATE------------------ Alterations end/or recommendations*----._....__ ____ - ------------------ ------- ----------- -_ ------ ......... -- _ ------------------------------------ .------------------_.--- ----------------------------------------- ..... - ----------------- --- ----- - ------ --------__ .-.-------------------------------------------------I------------ ------------------- -- --- ---------------------------------------- - ------------ -------------- ---------------' . ------------------------------------------------- ----------- -- y FINAL INSPECTION BY:. - ... ` - - .:,. Date - - -jy 04 - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. tla.elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca,California Tracy, California f.r.CO.