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,FOR OFFICE USE: r ------------------- - ------- - :. - --- APPLICATION FOR. ,SANITATION PERMIT Permit No. _r�_(-.�J3'�-=---- ----------------------- ---------- --------------------- (Complete in Duplicate)--------------------------- ------- Date Issued .sem_-a$=A/; ---------------------------- --- - - -----------,' 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. 5449 2--r7— ADDRESS AND LOCATION [� - - --- JOB P1 sr7 l lE ice_ r Q-: ' j� L ` ` i #. ----- Phone Owner`s.Name--•-----��----�---'-'-1-��--------- --�_1 Address--------- �_T----`--r'�---- ------. Q. -------- —D--------E.—Sc �-Q ....- Contractor's Name--- -E201tVaTs,------------------------------------------------------------ ------ --------------------------------------------- P hone--------------------------------- Installation -------------------•------------ Installation will serve: Residence [I-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms .3-- Number of-baths_3- Lot_sizer- -=Pr� =- ---------- Water Supply: Public system❑, Community system ❑ Private,�Depth to Water Table ft. Character of soil to a depth of 3 feet: Sane} Gravel! Saridy'Loam:❑ Clay Loam El Clay F1 ' Adobe 134 Hardpan ❑ I rr' ,•* {f e-.-..___...:.____.-I�yNo` New Constructson: Yes [� NoIQ Previous Application Made- (If yes,ddte-r FHA/VA: Ye No El OF INSTALLATION AND}SPECIFICATIONS-e (No,septic tank or cesspool,permitted-if public sewer.is availab�l,,e within-200 feet.) Septic` Distance from nearest `well. S�,-Distance fro m�foundaCon�'_JQ-_---._ _Material--j'P - -I~ -- --- to "�t7Z + _" `: ' S' �--x-r� X_. _ _Li uid�de th '�� Capacity �-rO-O---- �} No. of compartments'_--_-- - ---.-- i?e --- q P. /--.-_-__.Distance to nearest lot line_,_-.----. t� Disposal Field: Distance from nearest well__.�p�._Distance from Gfoundation_._____ _ - '. Li - # °Number of lines Length of each'line-------- of trench-_ __..��- aT e of filter rriaterial-:--j�7_C� __Depth of filter atenal------ --.-_---.Total length_.—'-� �-- ----- r' P Seepage Pit:7 Dista�n,ce to nearest well-I_._.----_- '4 Distance,.frroom; foundation____________________Distance to nearest lot line__.__.______-.. ❑ umber of pits--------------I-----Lining 'material. .--- Size: Diameter. Depth ? i Cess oolc Distance from nearest .weiL.__.______:_'�.pistance from foundation___________________Lining material___...__._____._.______.___________, � P rt - Depth-! Liquid Capacity gals. M ❑ Size: Diameter---------- /-=-------------- P C Privy: Distance from neeaTest well----------------------- --------- ----------Distance from nearest building--.--------------------------------- { ❑ Distance to nearest lot line-----------:-- ------- ----------------- ---------------------------------------------------- i: r 4 LR_ L-1^r ------- -5----------- Remodeling and/or repairing*(describe:_.___ � .---- T I f� ---�� -----5'Q(_Lw r R - u�1-,�, -----�------- Q _. } Q3�1/1 1? WITI- r_: r - --------=-------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S� laws and rules and regulations of the San Joaquin Local Health District, j_ 1 ( e t -------------- ------------------------------------- --------------- ----------- (Owner.and/or Contractor) � ,By:-------------- ------ ----------------------------------------------------------------------------------------- - -------------------------------------------- _ _{Title) �— (Plot plan- showing size of to#;Tocation of system in gelation tv we11s'6uildiri s, etc., can be laced on rsverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_--- - -=--------- ---- ----------------- DATE =----------- REVIEWEDBY \----------------------------------- ------- - ------------------------------------------------- + BUILDING PERMIT ISSUED------------------------------ -- - ---------------------------------- --------------------- ------- DATE----- -------------------------------- -, -=------------- - Alterations and/or recommendations:--------------------------- - -------------------------•----•---------- n:: ----------------------------------------------- - : ---- : i -- ------ ------------------------------------------- ----•--------------- INSP --- - - - Date `s �--------------------------- FINAL .w�., SAN JOAQUIN LOCAL HEALTH DISTRICT ryf 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Lodi,California Manteca,California Tracy,California- Stockton,California , F.P.CO. ''.. 1.