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r-UK UI-HU U5E; ---- -�--- G/ ---------------- ------- -------------- APPLICAT10a FOW SANITATION PERMIT Permit No. ---------------------- --------------------------------- (Complete in Duplicate) --------- ------------------------------------------ --- This Aermit Expires 1 Year From Date Issued Date Issued _j',,/_xn49 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 compliar ice with County Ordinance No. 549. JOB ADDRESS A LOCATION----- -J- �-- --- •------- `` .. Owner's Name a 't ------- Pho `fig_-,017ri�� Address___________________ rl 1 Contractor's Name_ � " �- p /-_ - -• ----•- -- - ►�.�1�----- ft ---.Pu++.-. 'Kone--- .dQ Installation will serve: Residence ❑ partment i-IoLse 31/'�Number m ercial Trailer rt Mot I ❑ ❑ el``❑ Other ❑ Number of living units: ---f -_ N er of bedrooms of baths -f_.- Lot size _.- 6 ------.7--./. - -------- { Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe Hardpan ❑ Previous Application Made: (If yes,ldate.____-- --. _ --) No El New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed if public se er is available within 200 feet.) Se�fic Tank: Distance from nearest well-AD Distance from fou dation__--1�-f--_ /;01.0 rtes Materials--- - --------------. - ------------- No. of compartmenfs--Z---.°_____ _________Size _ S[__A-3-Liquid del?th « 8 ---------Capac�tY Disposal Field: Distance from nearest we1IAjDf P-----Distance from foundation-1-0 r---___.Distance to nearest lot line-----49-_` Number of lines_________ ___________ __ _____Length of each line-J-Q-_f_-----___ Width of trench.�_�'� Type of filter materi Depth of filter material-_. - _�rTofial length } g ------ I Seepage Pit: Dis#ante to nearest well-- �-____Distance from foundation------ _.Distance to nearest lot line- .---___ _. _� i �� i:.. Number of pifis___ _________________Lining material- Q Size: Diameter- .._ �1_.-..-__.Depth-2:, __---__------------ ' ftpr Cesspool: Distance from nearest well-----------------Distance from oundation__----------------_.Lining❑ F. material_ _ .--__----..-------_Size: Diameter... -- --- ------Depth--------------------------------- G _-.___._-____ Liquid Capacity -----.gals. Privy: Distance from nearest well------------------------ ---------___Distance from nearest building �e .Distance to nearest lot line------------- ------------------------------------------- -------------------- ____ Remodeling ant}/or repairing (describe)------------------ _ - _ --------- ------- ------�--- - --- -.......... . ------- - -'hereby certify that hay repared this application and that the work will be done in accordance with San Joaquin Coun+y ordinances. State laws,�id rul and regulations of the San Joaquin Local Health District. y I (Signed)----------- `Lt---------- ------------------- - --=---------------------------------- 7 �ontrac+or) PiRC i7'Af�IK SII=tVICE By >4 M1n0PAve::----HaA-3841-:--------------------------- g - tleP ----------- _(Ti -- - - ---------- (Plo+ plan, showing size of lot, location of system in relation +o w s, buildin s, of can be laced on reverse side). FOR DEPART ENT USE ONL APPLICATION ACCEPTED BY........ 210. ---------=----------------------- DATE---- r�� aC iEWG E -- I ISS--- - -- ------- --------------------------------- DATE----- ------------------------------------------------------ -- - -UILDING PERMIT ISSUED DATE - ------------------------- Alterations and/or recommendations:.---- _..f>�G' -4 ----------------------------------------------------------------------------------------------------------------------------- ------------------------- -------------- FINAL INSPECTION BY:- __.le i Date --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave, : 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Co.