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[-UK UFrIC,L U,�)t: ---------------------------- -------- APPLICATION FOR SANITA`TIOI�!-.PERI t y i{ No. .............. N --------------------------------------------------------- (Complete in Duplicate) d - This Permit Expires 1 Year From Date Issued 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. 22x7-3-70—O 2-444700 E - V- JOB JOB ADDRESS AND LO ATION --S1DE-�7--- -C? /Q yrs ------ Qr-----•--)ES C6 4 Op 'q-------------- Owner's Name---------------- f.- Phone._ "-fr� Address " 3-- ----- ------ --�-5� - L'C71f Contractor's Name •lF "1 - - ------------------ -e,r/' ---- Phone ?- 's Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1.---. Number of bedrooms 3---- Number of baths _ Lot size ------t4cRE,P4 ______________________ 0 Water Supply: Public system ❑ Community system ❑ Private W3-'15epth to Water Table 25 ft. Character of soil to a depth of 3 feet: Sand W--'-G-ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date----- ----------..-I No i2-"_New Construction: Yes No ❑ FHA/VA: Yes E7-,--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS;. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well___,5 -----Distanc fRF rom foundation---- -.__.- Mafier'aL__CD/1/CllT ------- t [ No, of compartments------� __ ______Size--_ ,_(/iax Liquid depth__-1��--...._.Capacity___(_2©.0___ Disposal Field: Distance from nearest well-5-99--- Dist e f Qom' {pa ---dation----ID---__.__.Distance to nearest lot line----5 ___ -� Number of lines--- -----0----------------------Len o �ach'f it ne- --- ------ Width of trench-----2 -��------------------ Type of filter material__jj0CK_.---Depth of filter material__-�� ` -Total length----------------l_2©--- -_. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----_--_____-_. + ! ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------ Depth-----.----------------------- ---- Cesspool: Distance from .nearest wei!-----------------Distance from foundation--------------------Lining material--------------------------------------f El Size: Diameter- --------------- ------- --------Depth----------------------------- ----------------------Liquid Capacity----------------------------gal�J F. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------......... ❑ Distance to nearest lot lire-- --- ------------------------------- ----------------------------------------------------------- -------------- --------------------------- Remodeling and/or repairing (describe)------------------------------------__---------------------------------------------------------------------------------------------- ------------------- [0 ----------•---------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ------- ---------------------------------------------------------------------------------------------------------------------------------------------------•---------------- -------- - --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la ti s,, and rules and regulations of the San Joaquin Local Health District. (Signed)-- --- --------------------------------------- Owner and/or Contractor By:---------------------------------------------------------------- ------------------ ------- ------n------------------ {Tale)--------------- .. - - (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------------ -1 c. �D --- - - - ------------- ------------------------------------- DATE----------7-- J� = REVIEWEDBY--------------------------------------------------------------- --- -------------------- ------------------------------------- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED------------------------ ----------------------------------- DATE-------------------------------------------- Alterations and/or recommendations:._.._-. T�-------1 VE-V -S_r-_ )--------L41Q iQ. 1"T"--_-_- ---•---------- - ------------- ------ - T ------BET Dls`�_R� Qct f�Onf f�� EF F��,.i.r�_n!-�"`----------- ------------------------- ---------------------------------------- ---------------------------------- ------- FINAL INS Date_ -- --- --9_'. �-r----- '----------------------------- SAN JOAQUIN LOOAL 1,HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F F.P.CO.