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FOR OFFICE USE: , �y --------------------------------------------------------- i+ t APP (CATION FOR SANITATION PERMIT Permit No. ----------------------- ----------------------------- (Complete in Duplicate) Date Issued __.--------------------.---------.----------------------- 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. Al JOB ADDRESS AND LOC TIOl------/'71.�1�a�-�---.--_---_ 00-- - 1�( ' 1'ICfC?L> Owner's Name----------- Q}'11-Int----------------OA1__R_Q___��___----------------- -------------- ---------------------------- Phone.......-------------------------- Address_________________ _ i T-E-• --2--- -Oc'_k._---•_ 7----------A°'TC--------------------------------------------------------------- Contractor's Name------joLIVN-9-R-------------------------------------------------------------- --•-----••-•------------------------------•--- Phone......... ..................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A___ Number of bedrooms Number of baths _------ Lot size -----AK�RE -------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _--Vft. Character of soil to a depth of 3 feet: Sand B' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe 0 Hardpan F]Previous Application Made: (If yes,date______________-.-) No New Construction: Yes �o ❑ FHANA: Yes ❑ No jT TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well-----S _Dista e from foun��tion----,1, ___ Materi I_ eG�fCT� / No. of compartments..__. .. --__.____Size __ _ _....Liquid depth _-_ fCapaut: ___ _. Disposal Field: Distance from nearest well _Distance fro,��fo�'n-daion `� Distance to nearest lot line�.e __.__. Number of lines__ --_-- . ...... . .....Length of eac"�i line----__ Width of trench-._-_ Type of filter material-_-_Rh-Ck__.Depth of filter material-_..f -----------Total length------------------- Seepage Pit: Distance to nearest well_____________________Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------.----t ---Size: Diameter------.---------------Depth,-----------------.--------_.--_ Cesspool: Distance from nearest well-----------------Distance from foundation--------- ----------Lining material._____-`.---________-_____--_---_-. -------De th-------- ----------:-, Liquid Capacity gals. ❑ Size: Diameter - - - p 9 P y-------- ---------- Privy: Distance from nearest weJ1--------------------------------------------.___Distance from nearest building------.-----------_--________-----.-_ -._. ❑ Distance to nearest lot line-- --- ----------- ----------------------- ------------------------- -------------------------------------- -- ----------------------- Remodeling ----- ------ ------Remodeling and/or repairing (describe) ------ ------------- ----------------------------------------------------------------------------------------------------' ---------------------- ----------------------------------------------------------------------- --- ----------------- 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 and regulations of the San Joaquin Local Health District. (Signed)------ V - ----- -- - (Owner`and/or Contractor] By:....................................-------------------------------------------------------------------- -------------------------(Title)--------------- -------- ------ -- -- -- --------- (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-----TIR.-0-------------------------------------------------------------------- DATE-------- --------- REVIEWEDBY-------------------------- ----------------------- ------- -------- -------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--- --------------------------------------------------•--------------------------------------- DATE..--- ------------------------------------ / --------- -- Alterations and/or recommendations:._ -*71— 0 * ' - .0ee 1 �/Ails.._..0�1�, __.._,,?,�,)r!_��_._- +4/1¢E_�_.,.,__--_i. ' -1-D---= BAIRV.s------1-T----WA_U,,D..- - -at --------N_�------TV_ -fKAT.At-�- t4pl?�.1'?pNtl 2 2 !---- ---------------------------------------------- --- 1� �}1 ---------- ----------- ----------- .--...__._------.._-.-. ___-Y.__..... __ Farr vel - g' " 2 W1�. _cSAcH- ------------------------------------- b, �c+� a, ----- - v1'1- N>�E � "� f ------------------------ --- --------- - - - -------- FINAL WSPECT�QhL 8Y-:,, ? -- -- --- Date Q �_+ _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California V Manteca,California Tracy,California F.P.C C.