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FOR�F�IC�USE: -------- -I --- ---------- ; APPLICATION FOR SANITATION PERMIT Permit No. --- ---- --------- 1 - {Completen'Duplicatej / ° "` - Date Issued - -t " -.--- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Districtfor,a permit to construct and iristall the work herein described. This application is made in compliance with County Ordinance No..549. '%, JOB ADDRESS AND LOCATION------- _______• ___--- r r ----- Owner s Name------- J �.yf -------- -- -------- -------- hone Address-----------11- �A /yam' - - ------------------------------ ---------•--•------•------------------------------.- Contractor's Name------ --- -•---- -----------------------I---------------•-- --------- ------ Phone.-- •.0 Y=_-SZ-7(_ Installation will serve: Residence ❑ Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __/---- Number of bedrooms _ Number of baths_ Lot size --3 -'t_-74��[ /-Q.SY_7, L Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -"-r+fit. J. I Character of soil to a depthof 3 feet: Sand ❑ Gravel❑ Sandy,Loam ❑ Clay Loam ❑ Clay ❑ Adobe E• Hardpan ❑ Previous Application Made: f (If yes,date------.-----------__) No R- New Construction: Yes ❑ No 0— FHA/VA: Yes P No ❑ ! TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within'200 feet.) Septic Tank: Distanceifrom nearest we!L_Aeo-------Distance from foundation--._l-A- ......Material:___ ------------------ i 7 p Liquid depth------- Y! CapacitYcr tt , �. No. oceom artments----__-J-------___-.--Size...-_aJ--x_ x- Disposal .Field: ,I �yfoundation - 1 c-� Numbedof rom.nearest well.-�C-�.,---_-Distance from ---�.a-_�--_--.-Distancel to nearest lot YP i s hof lines---------J-------------------------Length of each line-_6 '.� _�-�_Y'Width of trench------ ---..----__ Type of efilter material--- ------Depth of filter material ---IX_'.----.--._Total 'length------i-9-0_`.--t-c�•^�-�--- O I / , Seepage Pit: Qistanceii#o nearest well_- �___--------Distance from foundation---f_Ct--___.--.Distance to nearest lot line...----.---_.• Number.of Its----- W +� p L1'f p Lining material ��#G! :` $ize: biometer:- x_3.3. De th - �.a .. Cesspool: stance'from nearest well------------- from foundation----- ----------_----Lining material--- ---------__-_.-..------_----__-._ ❑ Size: I er------------------------- - ----------Depth------ ----- ---------- Liquid Capacity -----gals. Priv Distancel,.from nearer 4 # Y I: ------------- -Distanceifrom nearest building----------------------------- --------- --- ❑ Dlstancel:fo nearest lot line-------------------------- ---------------------------------=-----------------------'---------------- ---- ----------- Remodeling and/or repairing (descril�e�-------------------- -- --- -! # - - ------------------------------------------------ -- -- ------ I i ------- --------------- - -- --- -- - ------------------------------------------------ - s ----------------------------------- ------------° if s I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa�t-),,County ordinances, State laws, and rules and regulations of the San Joaquin'Local Health District. C (Signed)--------------- -------------- ' - -� - �. ° x (Owner. Contras to ------------ + t , BY , ------------------ {Title)'" - -------------- --- --- ----- ---- ------------ (Plot plan, showing size of lot, location of system in relation to wells,'buildings, etc., can be placed on:reverse side). tt FOR DEPARTMENT USE ONLY ! i APPLICATION ACCEPTED B, --_ 'P :1 L-- DATE = - � ----- -- - --- --- 1. REVIEWED BY -------------'� ---------- ------ -- € I DATE------- ' Alterations nd or recommeri ' _ DA•TE.-_-_-__-_f._9______________---_------- dations:------- t 6 #�, r` ------- ------------------------ ------------ ----------------------- --------- ,-.---.C^-_r- ------------------------------ -------------- ------------------•- ----------------------------,------------- ----------------------- ------------ ---------------=----------------------------------- - ------------------------------------------------- ------------------------------ ------ FINAL INSPECTION BY:-_ 1 I 14�fLodi,California Il ---L-`r---- Date J + t !i QUIN LOCAL HEALTH DISTRICT I 1601 E.Haalfon Are.�fe treet 124 Sycamore Street 205 West 9th Street Stockton,California Manteca,California Tracy,California i� F.F.0 Q.