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FOR OFFICE U5 _ ----------- APPLICATION : FOR`_SANITATION PERMIT Permit No. -- ----� (Complete in Duplicated //' Date Issued ----- . ..Q � � —----------- - - = ------ �T--'�7,�- ; This Permit Ex `sires 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. Th' : tion is rin compfian it County Ordin3c�o. 549., ° '008 ADDRL° LZ_ 0 - -- -- ------- P . -----Q_ "..&f X Owner's Name. - ESN Milli ....... ---.Ir J 1�� !�-OME`�-_--------_-- Phone�� Address------- •._....' ( C°c9ZA1 (Se/V-, ! Contractors Name--------------•'-____-- � PhonC7h.`� lnstalla mber of iill vRe in uni 9 nce Number of bedrooms) i r Z. p {f j Commercial ❑ Trailer Court E] Motel [:1 Other ❑ _ j Nbf bathsLi Number o . Lot size -------Q___________•----__ .-t.----------------------- Water-Stipply: Public system ❑ Community system ❑ Private E5 Depth to Water Table-`6 ft. Character of soil•to a depth of�3 feet: Sand ❑ Gravel'❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: lif„yes,date____________________) No ❑ New Construction: Yes No ❑ FHA/VA: es 5; No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well__l62_-_____Distance from foundation__/a-----------Material___ No. of compartments----:__ ------------ Liquid depth_ Z'-_____________CapacitY_/- 17 Disposal Field: Distance from nearest well-_Z®O-._--_.Distance from foundation-��_�___. __Dis#ante to nearest lot line------ Number of,lines.°_. D_______________ __Length of each line____ Width of french._ _¢------------------------ Type of filter maferial.,Ief1(�---_-----Depth of filter material---/------ ----------Total length---- 7�-----------------_------------ Seepage Pit: s Distance to nearest well__,.Q0---------Distance from foundation-__7�._...__..Distance to nearest lot line__ Nu _._.__._._. mber of Fts----IV-_----_- ` f p ___Lining material__��(r/�c =Size: Diameter___�.�_f_.__..___Depth___xZ_,�_�______ __ Cesspool: Distance from nearest well-----------------Distance from foundation. __________--_ti _ .__.Lining material_____-____.._ ________.________. F-1 Size: Diameter-_` ----------=---------- ------Depth-------- ------------- --------• -----------------Liquid Capacity-----------••-------•---••--gals. + Privy:-,' Distance from nearest well----------------------------------------------------Distance from nearest building ❑ Qistance to nearest lot line ---------------------------=-------------••----------•------------- -------------•---------------------------------------- Remodelin9 and/or repairing describe): 55 � - 1_ F•---'—�'------ -----------------------• --------------------•---------------------------------------�—4 4 -- �� -------- LSA r -------------------------•------- ----------------------------------------------------------- - I hereby certify that l h--e prepared ' application`and that the work will be done in accordance with San Joaquin County I ordinances, Stat law,, rules and r gula ions o the San Joaquin Local Health District. (Signe$ ---------- Gtwt.t. (Owner and/or Contractor) By: ---------------- -- -- - ------ ---------------(riifle)----- (Piot plan, showing size of to , oca+ion of system in relation to wells, buildings, etc., can be pla d on reverse side). { ,.w , FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BYl___ ✓�i � � �� '• -- 4" r- / --------------------------------- DATE- - c �� - REVIEWED BY --------------------------•-k----------•---------------------•--- DATE BUILDING PERMIT ISSUED -----------------------------'------------------------------------------------- DA•TE.----------------- Altera+ions and/or recommendations: ------------------------------------------------------•--------•------------ ----------••-------•------ •-----••---•--- -----.�#A_r_r=_a b =------------------ ----------- - ----------------------------------- - ��-� <. � = - ------------------ 4 FINAL INSPECTION S'•Y,._ ,_-_--- _�.f - -- "- r ----------�.��._.,,; Date----------- --------- � s- SAN.JOAQUIN LOCAL HEALTH DISTRICT 30 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California- Manteca,.California' Tracy,California f d C8.4 REVISED 8-39 F.P.0 iI. 7M 6.613