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FOROFFICE USE: _ ------------------------- -------------- ------------ -- APPLICATION POR-`SANITATION PERMIT Permit No. --- ------------------ -----=-------- --------------- (Complefe in Duplicate) ------ ------------- -- -------------------------- This Permit Expires 1 Year From Date Issued Date Issued 2S?_27�o Z6 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-wit nt .O dinance No-,549. � ,._. 6 , lav JOB ADDRESS AND LOC ATION------ _l-- �-___ �y Owner's Name_______________ _'_ot_114 1 - E �*�------ ----------—------- Phone------------------------------------ -- - 1`7, ------------ --------------------------- Address------------------ �I -- ----------- -`7,-----------T-(-j't�_l`�-------------------------------------- Contractor's Name----0_WAj-_F•.t�----------------• -------------------- ------------------------- Phone Installation will serve: Residence Ej'Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: _- +_. Number of bedrooms -3- Number of baths _f---__ Lot size __A R_l�______._ Water Supply: Public system ❑ Community system [❑ Private E]-'-Depth to Water Table -17 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [D' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made:,{If yes,date--------------------} No ©/ New Construction: Yes D5'-No ❑ FHA/VA: Yes ❑ No ❑� TYPE OF INSTALLATION`%AND- SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic a-ank: ,'D s arce'from nearest well_. Dista ce from foundation_____ _"-.__.Mat rial_ .___!_I_ .__. f l- '_ ❑ r" No. of compartments_ Size__ ____ _ _ ___�_-._-Li Liquid /` C1�______ h 8 --------- Disposal Field: Distar5ce from nearest well .-,-Distan� from foundation d depth._Distance to nearest I,ty $ ,� of line. 1 Number of lines-----------------------------------Length of each line__C�_. :. + -- -Width of trench-----.-13-ca-- --,-----_- -- op Type of filter material--_R cK-----Depth of filter material__-__! ---- Total length--------fd©-----------•-_----_- Seepage Pit: Distance fo nearest well-._-,/---0------Distance from foundation----l0_____-_- istance to nearest lot line____z�_______-_ . [ Number of pits-----:I-------------Lining materiaf_� ?.©_C .....Size: Diameter_-X_-X__. ---Depth.---- ------------------------- ~� Cesspool: Distance from nearest well--------------..-Distance from €oundation--------------------Lining maferial----.--___._-____--_-_-._-_______... ❑ Size: Diameter--------------------------- - -------=Depth- ---------I----------------------- Liquid.__Capac tyv _. _ _ - .amu..' _ Privy: i Distance from nearest well----- ------- _ __._._bistance from nearest building ❑ Distance to nearest lot line-----._-___.._.-_.__ - - -- Remodeling'and/or repairing (describe):----------------------------------------------------- t . --•-------------------------------•---------------------------•---------------__------- : ------------- -------------- --------------------- •----- --------- ----------------------------------- --------------------------=--------------- --- -------------------------------------- -------------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance wifh San Joaquin County e ordinances, State laws, and rules an regulations of the San Joaquin Local Health'District. (Signed) `-x,Z —°- - - 4 --�—�t:�.----__---•--�--�----�------- .._r_._,-_ _.-____(Owner and/or-Contractor]_ By ; #------------------ ---------••--- --------------- ----- -€ = _.:----------------------------------------(Title)---------- -------------------- ------- --- --- -------- (Piot plan; showing size of lot, location of system in relation fo;wells, buildings, etc., can be placed on reverse side). -f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDABY_ vt" -`------- ------------- - ----- DATE--------!_G?-----'� ------ -------- ---------------- REVIEWED:_BY------------------------------------- ------ DATE --------------------- BUILDING PERMIT ISSUED----------------- ----------------- ------------------------------------------------- ------------- DA•TE-------------- - -- - Alterations and/or recommendations------------ ---- ---------------------------- . ---------------------------- ------------------------------------ ------- - -------------- ,r FINAL I N BY: - --- Date.--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street •- 124 Sycamore Street. y 205 West 91h Street Stockton,California Lodi, California ' .�-.. _ Manteca, California Tracy, California F.P.C q.