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6U�tUFFICE USE: -- ----------- �� -s--=--- ----------- ---------- Q-' Q APPLICATION POR SANITATION PERMIT Permit No. .__�_.�.�-/Zf ------------------------------------------------ ------- Complete in Duplicate) ------ --------- ----- --------- d �S --- - --- --- This Permit 1 Year From Date Issued 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, JOB ADDRESS AND LOCATION---_------------ 706 P ' ----- - - - ----------- --- ------------ OName --- 4ohl wa----------- ---- •------------•----- ------------ -- -----•------ ------- -----:--- ---------- -._._ Phone-.-----� " �--------- --------- Address -------••-- 2706 Pook asoGI� CaWO=, - ------•---•-•---------•------•-----------••-------------- ----•-----------------------------------------•-----•--------------------------- ---.--------• - -•- •--- Contractor'sName------= r i w-----------trri ►----& so= 1[ e ----•- •-----------•------- --- ------- ----------- --------------- ------ ---------------•---- Phone.......466'e960�-----= -- i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms'=___- Number of bathsli___ Lot size'--: _- 1AZ_ 'fit Water Supply:. Public .system ❑ Community system [] Private M Depth to Water Table _ t ft. Character of soil to a.depth of 3 feet: ;Sand ❑ Graver❑ . Sandy Loam ❑ Ciay Loam A Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) ,No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE .OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perrriitted if public sewer is available within 200 feet.)- _ *' , e nn Septic Tank; Distance from nearest well----- .-._-Distancer from fo?urida#io�n______ Material-------tool! '� e$.__.•-----__ No. 'of com`P artments------- ----------- - --Size-=---•--6'_ 7 =;S__Li uid de'Rlk-------541!-.-___.____ Capacity Disposal Field: Distancb from nearest well li......Distance'frcm foundation_--- f_.---.-_Distance to nearest lot line_-_--____-_____ ® Number of lines_____ ------ --- ---Length of each line--- __ ,_ _______75kiclfh of trench__ __._-� __.--__ -_----_-- �Type^of filer material-____- -- - _----Depth of filter ma#erial_ _-- - - -- ------ length______-- 1 -------- --------- Seepage Pit: Distance to nearest well----_ !"#._ Distance from foundation_______ - �Q_____- Distance to nearest lot line_________________ + Lining i _-__ -.Size: Number,of pits______.;. .--------- g-material--.- Diameter------- 1 \ 1 Cesspool: Distancerfrom nearest well--------- -------__Distance from foundation------------------- Lining material__ --------------- ------------------ ❑ Size: Diameter------- =---- ------------------------Depth------------------�-----y--------------------- Liquid Capacity-.-------------- gals. (t� Privy: Distance-from nearest well__-------------------- ---------- ---t-_ .................. _ .Distance from nearest building - - ----- ----- - ❑ Distance to nearest lot line___________ - ------------------------------------------------------------------------------------ ------------------ �emodeling and/or repairing (describe):____-- __-__ -------------------------------------------------------- t __ tea -•-----•----- ------------ ------------ -- ---------- ------------------ --- ----- ---- ' ---- - - -- I hereby certify that I have - - - Y Y prepared this application and that the work will be done in accordance with San Joaquin County, k ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------ '0*A* P&T% h ?-:S IM• ---- - ---- --- ----------------------------- ------------------_----------- -----(Owner and/or Contractor) BY �.. .. _ --e ----- --- ---------------------------------------------(Title)--- -ut t4r - ------------------------------- (Plot plan, showing size of lot, location of system in re a ion to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..._(r-,- . -------------------- ------------------------------------------- DATE --- ................ REVIEWED BY------------------------------------- '- - -- - -- - --- " DATE BUILDING PERMIT ISSUED------------- ------i------------------------------------- a z - -_-__-.-__ �� �DATE--------------y__-A -------------------- Alterations and/or recommendations:_ _ S ---------------------------- --- _--- --------------------- ----- __._- ------ - ----------- ----- --- �----� � ------dkaf ----------------------------- 1, ------------------ FINAL INSPECTION BY:---- - ____.__-__.-__-- �r- -------- ---------- Date----- ) SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street) 205 West 9Th Street Vockton,California Lodi, California Manteca, California; Tracy,California F.P.Ca. I