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FOR OFFICE USE: - - ------------------------------------------ -------- _.----_ APPLICATION �O_R ,SANITATION PERMIT Permit No. ��.,� ------------------------------- --------------------- (Complete to 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 Lpmpliance ith County Ordinance No. 549. Tia z_E�)c_ u ,23 JOB ADDRESS AND LO ATIOF----- O___.14!-RF'oR' ...WR.Y_-____-CAR.D_0ZP-----cALBI�----- '47 .P_.. � c_ 'rp �__ u1__. ? `Ly ''3673 Owner's Name --___- -. Phone Address ' - f�l�l / )'�-1C ( � ) ° r1 �� ' ----- -? Contractor's Name-------4OW—Al ----------------------------------------------------------------------------------------------- -------------- Phone----------------------------------- Installation will serve: Residence ©Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----I-.- Number of bedrooms J----- Number of baths -1.-.-- Lot size .-.-/5_ _0P0 Q---._.-f------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table /2_ ft. 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 J!5'— New Construction: Yes ❑ No [ FHA/VA: Yes ❑ Nom 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-- _.ti /____Distance from foundation---2a---------.Mate [] Tal- <f6ATf - E - _._.._____... _:-_-._..---No. of compartments depth_ __-z-____.__Capacity...- r 6 Disposal Field: Distance from nearest well__C AW--Distance from foundation....--.I ----..Distance to nearest lot line -5..... J Number of lines-------------/...................Length of each line------ -- ------- 0__._._.Width of trench..._-___��.�_------------- OQ Type of filter material---RQC_K-----Depth of filter material-----/g___-._-.-__Total length----------------- -----_--_-._.--.-.._ (� Seepage Pit: Distance to nearest well-------------_-------Distance from foundation--------------------Distance to nearest lot line----------------- F] Number of pits-----._.--------------Lining material-----------------------Size: Diameter---.-------------------Depth._---_..______-----..._.__.-.._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_____.__---- -------------------- r ❑ Size: Diameter--------------------- -- ._Depth--------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ F-1 Distance to nearest lot line- -------------------------------------------------------------------------------------------------------------------•------------------- Remodeling and/or repairing (describe):.____ MMtER__'_-.-----.Ell=1 _E_E-N- ---.--- _ &1- ------------------------------------------------------ 1• ---------------------------- ----------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. n ` f ---------------------(Owner and/or Contractor)(Signed) -------------------------------- (- C—-- 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------ �t R_�_0 ---------------- --------------------------------------------------- DATE-------7'_29'__.h6-'--------------------- REVIEWEDBY-----------------------------------------------__----------------------------- --------------------------- ----------------- DATE......._--------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------- Alterationsand/or recommendations---------------- ------------ ------------------------------_------------------------------------------------------------------------------------------------- ---------------------------------- ---------------------------------- ---------------------------- ------------------------------------I-------------------------------------------------------------------I---------------- ---------------------------------------------------------------- ----------------------- ---------------------------------------_--------------------------- -------------------------------------------- ----------------- ------------ •----------------- -•---- -- - ---- -- --- ---------- ------------------------------- ------------------------------------------- ---------------- - - - - ------- �- ------ --- - -- Date za -E�- -------------------------------- FINAL INSP N BY:- 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 Manteca,California Tracy,California fir.s