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FOR OFFICE ----------------- ------ ------- -------- - Permit APPLICATION FOR SANITATION PERMIT ------------------------------------------------- (Complete in Duplicate) pate Issued ---------- • --__----_-------- This Permit Ex fires 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. [� / h -------- { JOB ADDRESS AND LOCATION_-_.1.�p--------- pr_�_I- .c--------RD--------------------------------------- Owner's Name----------------- =- RTriU-K-------- ------- .. .......I -------- _TKN) Address-------------------------------- � Phone.------•------'-----•-------------- Contractor's Name--------C RG_IA�ZZ--`---------------- ----------- - Apartment House ❑ Commercial ❑ Trailer�'h [tom Motel ❑ Other ❑ Installation will serve: Residence ❑ p j Lot size 1 - - -�. r. - Number of living units: __F-_-- Number of bedrooms -� Number of baths r_-- _ Water Supply: Public system ❑ . C mmunity system F1Private Depth fc Water Table � - ft. Clay ❑ Adobe❑ Hardpan ❑ Character of soil to a depth of 3 feet Sand E] S Gravel Saandy Loam ❑ Clay Loam ❑ Previous Application Made: (if yes date_.- 1 No el New Construction: Yes [INo �F�A/VA: Yes ❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS: _R�`__ jNo,sepiic.tankror cesspool permitted ifTpublic_sewerYis_evaikable with+n,200 feet.) ::>,w i • .la " , Septic Tank: Distance from' nearest well__:�1�_____Distanc from foundation__ __ _ - �0�77 No.,of compartments--------- ---- --.Size__ 'ID- ---!---Liquid depth_ --------Capacity__.] - 't 4 Disposal Field: Distance from nearest well::.., + "---Distance'tfrom foundat'on_ ----•---- istance to nearest lot line___--• o �. Number of lines--.------2 ------------------ ------ -----Length of each line.._ -Widfih of trench.__.__ _--_ _--.�------------- p ... , dotal `.len length Type of,fiiter material_11 ._'. -a "-De th of filter'matera!-__-1_ _.____ 9 ,I `I _ __--Linin material_.______..___----"--`Si1 _ Distance to nearest lot line_---------------- Seepage _______________ Seems e Pit: Number of pi}arest well---------------- Distance from foundation Diameter----------------- Depth-------------------------------- p g - I , Cesspool: D•rstance'from nearest well-"-------_------Distance from foundation--------- -------Lining material__ ----._-_---- ----"" els. 1 Depth-.-------------------------------------------------Liquid Capacity---------------------------9 Size: Diameter_._...__'--___-�------'- --'" -' k ❑ i ______-Distance from nearest building. Distance from nearest well --------------- - ---------------------------------- Privy: ----------- -------------------------- Privy: v ,r --------- ' �I Distance to nearest of me______________________._-- -------------- Remodeling and/or repairing (describej--- ------------------------------- --------- F i -------------------------------------------------------------•---- ----------------- -----------------------f-- ---- - - -------- - -- --- ------ -------- -----= ------ - --- -- - -- I hereby certify that l 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. � :. •• "t -------------------------------------------------------- (Signed ------------------------------'---- -------(Owner and/or Contractor] ; . [Title----------------------------- BY�------------------------------------------ - - _---------- ells. . _ ..� .� �r- t [Plot plan, showing size of lot, location of system in,relation to weNs, buildings, etc., can be laced on reverse side). 1, FOR DEPARTMENT USE ONLY l ' ----- ---------- --'------- -'------- DATE-- ---'/-�- - - -- '- -' -'---=�`-------' '----' APPLICATION ACCEPTED BY-------T-Y-- AO-`---------------------- ' --------------------------------------------- DATE-- - --------- ' ------ -----•-,--- --'--;---------- REVIEWED --- ---- I REVIEWED BY--------"------------- 'BUILDING'PERMIT ISSUED-----".---_----- ----------------------------------- recommendation's ----•-- -------------- - ------ -�----'-- -- ------�-------'•--'------ - DATE------ --------- --------- --' -------'-- --------- -- Alterations and/or recommendations:------...7TIZ14-7-_.k4pc_----NOT-----1_Frs-7-11-t•-i �----------------••----------•------------•----------------------- ;--- -----------=-------- ----- -•---------- r ------------------------------- --------- ____ _______ _ __________________ ____ ._. ---------------------------- --------- - - ~ Date- -------------J/----- --- ---- ----------------------- EC f -FINAL INSPBY:... ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. L 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,Calif ornia Lodi,California Manteca,California Tracy,California F.P.Co•