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FO OFFICE USE- - SE: r-----------1.6- ---- - r APPLICATION FORfSANITATION PERMIT Permit No. __L..._Z___._ 7 i { } P1=i------- 1 (Complete in Duplicate) r Date issued -------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. This application is made in compliance with County Ord- ce No. 549. t y+ N _f, JOB ADDRESS AND LOCATION---------- ! "` =- --------- f Owner's Name tt L ti L C - K-i � -rr "4 Phonti --` _ 3 -----------------------------------------V) ----- ._....--`- `----------------------------------•----------------...-------- ------- ---------- Contractor's Name---------------------------------- _CZn- �S 1" ---------------------------------------------- Phone-4 .65_- -0- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Ne Number of living units: - --__- Number of bedrooms __':L_Wvmber of baths ---I--- Lot size ...-.-_-.- `-,--��--------------- WaterSupply: Public system Community system ElPrivate E] Depth to Water Table -------- ftp 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�9_ New Construction: Yes ❑ Nox FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material_-_---.--._.'_-----._-_---------_-_-...__-_.__._. ❑ No. of compartments---------- ---------- ----Size------- ---------- ---Liquid depth--------- ---------------Capacity---------------------- Dis osaI Field: Distance from nearest well-...-'`.-.-.--'Distance from foundation--1-C------------Distance to nearest lot line__---.----- 7 Number of lines__________________{� _____Length of each line-------1-. __ f Width of trench.__ Type of filter material____ __�I(_ tDepth of filter ma#eriaL___.1._�_----/____Total length-------. 77.1------------------------ Seepage _----__-!______-__---.- See a e Pit: Distance to nearest well___'-�-- D•sstance fro fou dation----1s3._..__..Distance to nearest lot line�C-_ �___-- 1 [ ize: Diameter._ T' �� Number of p -------- Lining material---- --- �,• - z3_s�------------Depth-�� -------------- Cesspool, Distance from nearest well-------------____Distance from foundation--------------------Lining materia3_------------------------------------ ❑ Size: Diameter------------------------ Depth---------------------------------- -----------------Liquid Capacity,- ------------------ -----gals. et Priv Distance from nearest.well----------------------- ---__Distance from nearest building-. ❑ Distance to nearest lot line - -- ------------- Remodeling and/or repairing (d --escribe}-------------- ---------- --•-- ----- --------•-- �!-c -�r�----• �O -----------------•--•--------------------------------------------------------------------------------------•---•---------------- --------------------------------- ---------------------•---------------- ----------------- -----------------------...--------------------------------------------------------------------------------------------------------------------. --------------------------- --------------------------------------------- -----------------------------------------------------------------------------• ---------------------------------•------- ----------------------------------------------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an ns of the San Joaquin Local Health District. �(Si (Signed) ------------------- -- ---------------------- and/or Contractor) - Title (Piot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------1451,215f,---e—IV,--------- ----------------------------------------------- DATE---------- ---_`---------- I' REVIEWEDBY----- ------- --------------------------- --- --------------------------------- --- ------------ ----------------------- ----- DATE------- -------- BUILDING PERMIT ISSUED------------ = _ E Alterations and/or recommendations:---------�� ------- r•------------------------------- --- - --------- ----------- - - ------------- ------------••----------------- ----------------------------------------------------------------------------------------------------------------------------------------•------------------- ----- I t ) .........................................................................}----------------------------------------------------------------------._.----------------------------.-------------------------------._.__.----.._- FWAL INSPECTION BY:-------- --- -------- Date -._--�.- � �1 - rJOAQUIN - ----------------------------------- SAN LOCAL HEALTH DISTRICT 1601 E.Noxenon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.❑.C A.