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FOR QFjICE:USE: -- --- ------ --------------------------- -_---_----'---- APPLICATION FOR S-ANItATION PERMIT Permit No. .o k (Complete in Duplicate) .�,.- Lr Date Issued -- __ _____________ _ _ _ ________ ____ kThrs Perm it.Expires 1.Year,From•Date,Issued - � r Application is hereby made to the San Joaquin tLncal Health District fora,permit to constructer and-i call the work herein described. This application is made in cbmpiian with County Ordinance No. 549. �I`} Uf 3JOB ADDRESS AND LJA ATVI . S [L L— �. �Il. <tf-cam. ��?Q_ CI --L.MP _. ,/ - Phone--------------------•-•--------- Owner's Name---------------- C K-......... .!`�.Qv�.�,�--•�-•--•------ ------------------------------------------- -- ---- - -- �j - y Address-- -------------C RT- f--`•II_;3--'-------- 7.g� mTC19 € ni --•---•--------------------------------------------------- Contractor's Name--------- _LFIIAI.E K------••-•----••-•---------- --------------------------------------------••-------------------------•---- Phone----------------------------------- I: Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r !� tAf Number of living unit`s: ______ Number of bedrooms - --- Number of baths ______-_ Lot size __-_I_________________.__._. -------------------.__--- .a 3�+rGJ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table f+ I Character of soil to a depth�of 3 feet:, SAd,0Gravel ❑—Sa.ndy_Lo ❑—Clay.�Loam ❑„�Cla.y I Adobe❑ Hardpan ❑ it .0.0 E Previous Application Made:i (If yes date. __-- No New Construction: Yes �No ❑ FHA/VA: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: septicfnk-or cesspool pe`r`mifted-if public sewer is avallab"le4within'-20Q feefj""` II • Septic Tank: Distance from nearest well--5P------Distant from foundation__��____-____.Mater al`�FD1 t�>________-_-__-_- I ,� No. of,compartments------_.�________-__Size_y.,y _X-5-1-Liquid depth_--'f _______Capacity___f ZO--------- f ---- DisposalFId: Distance from nearest well._ ....-Distance f om foundation___) ____-___-Distance: to .nearest lot line__J� .__-._._. Number - u �''of lines________ - Length of each lirie_ _o- ZWidth of t ench____2 -___ !�- g .� Seepage Pit: Distance, material___R10-C "�_._.__De Depth of filter maternal. __l__pQ. Total len th--------------------2�0________- Type of; p �, f------- ---- 9, to nearest well----------------------Distance from found on ----------------Distan! to nearest lot line__-__-_-_____-_ ❑ Numberjiof pFis----------------------Lining material--------------------'Size: biaimeter-•-------------�'--"� Depth--------------------------------- II 1 f Cesspool: Distance from nearest weld_ __ Dista rice from foundation_-___-_:. .____-__..Lining material--------------------_ __-_-________ D ❑ Size: DIIllmeter------------------ -----------Depth ---------- E�" - Liquid Capacity gals. Privy: Distance from nearest well-_________________ ________ ____________________Distance from' nearest building ❑ Distance) to nearest lot line-.,------------- l .. _ �. it _ Remodeling and/or repairing (describe):_ t _ ' f - it ---------------- -A-------------------------- " 40 ----1-------I--------------------------------------- � - ------ ----- ------ ------ ---------------- ------- ------- - -- ------------- - 1 __------- --------- - ------------------------------------------------------ - ------------- -- - 1 hereby certify that I have prepared this application and ithat the work will be done in accordance with San Joaquin County ordinances, State laws, and l,rules and reg at ions of the San Jbaquin�Local Health District. , 1 ---------------------------------------------------------- -----(Owner and/or Contractor) (Signed) -- -------------- Plot plan, shot'' size of lot, location of s stem in relation to wells, buildings, etc., c3r[Title�'_____ v JLL ( p g y '�` a' g n be placed on reverse side). I! i " `! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED, BY-------` .- . 0---- - ---------------------------- ---------------- DATE---- ". f� '------•---•---•- REVIEWEDBY -------------u------------ -------- --- -------------------------------------------------------- DATE BUILDING PERMIT ISSUED-` --------------------------------------------------------------------------------------------------- DATE--------------------------------`----•------------------ Alterations and/or recommendations:_____f."_ =-6tS.`-___C1DRI3E�Tlo -----IV _,_.__Ql ----71.me--------_--4%o5_---------1-A_k0--.--- ----------------- ------- ------------------------------------------------------------------- -------------------------------- FINAL INSPEC -' Date--- _. _._J�~._^�/A-.......------- SAN JOAQUIN LOCAL HEALTH DISTRICT 7401 E.Hazelton Ave_i 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Ili Lodi,California Manteca,California Tracy,California � II