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rl,�llc vrr�lt' VJ r ----'-- J 7Z, Q �- _____ ,/--------------7�' APPLICAVON, �R SANITATION PERMIT Permit No. _.__ .. , .. ----------------------------------------- --------------- (Complete in Duplicate) Date Issued ..../. "/ �7-- -------------- 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. 54 . JOB ADDRESS Affq LO ATION.._ ....... 1 ..... ------ --•- r ........-_------------------------ ....... Owner's Name------ --• • - - -_-• ,�„� -L(✓ -- - --- ...--•-------••---• Phone.................................... Address-------------- •----••-• , --- ---•---- Contractor's Name C� 1F...1_�� 1 ------ -c• -..t--- .9'... Y- ---------------------- Phory --- . Installation will serve: Residence 91�_Xppartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ N bar of bedrooms Number of baths ./-. Lot size _.-s ��_..�...? ......1. --- Wafer -Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Of. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ , Previous Application Made: (If yes,date--------------------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank or cesspool permitted if public sewer is available within 200 fe" Septic Tank- Distance from nearest well_Wrfr_Distance from foundation---/. ---------Material.........�' No. of compartments..___ Z------------.--Size-�,,i7Z/�2C3 V!_:--•Liquid depth_�x-----------Capacity----[ Disposal Fi Distance from nearest well_?400�__Disi'anceEfroLndation----/._5..."Distance to nearest lot li�_�Z.Q... Number of lines--------,/.._ D�__rr__-Length of each line_.. '_Lfl_________________Width of french-------�.c.+'Z-.....___.____._.___.._. Type of filter material._. _L1.1/4___Depth of filter material------/� _Total length____....f-'V-• -�--------------- Seepage P' . Distance to nearest well_ tfDistance om foundati rc ,�j __........Distance to nearest lot line.____._ ' Number of pits__./-______________Lining material. ___...Size: Diameter__�_��!_____.Depth__...�_�,f".r___.__.__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------.___..Lining material..._.______._________--------__-•____ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity.. gals. Privy: Distance from nearest well----------------------------_-----------__.......Distance from nearest building______.___.-----_---_______________._____- ❑ Distance to nearest lot line------------------------------------------------•---------------•----- Remodeling and/or repairing (describe):-------- -------•-------------------•-•------•----------• •------•--•--------.----------•--•---..----------•----------------- q -••-----•---•---•---•----------------------------•--------------------------- -- - -------•---------••---------------------•.......------------------------- -- --- • 7. ----------------------•---------------..._.----------------•-------------•---------•---------------•------ - ---•---------------------------------•------•------------------------------ --------------------------------- I here b c ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, d rules �dd regul�ati(ons of the San quip Local Health District. (Signed) ` 1= a'i ---- -•--------------------------------------------------- r Contractor By:------------------------------------------------------- ----- (Title)------------------------------------------------ -------------- 7-d ------- ---- (Plot plan, showing size of lot, location of system in r ion to wells, bu'dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------C-'-• `�.5--- ------------------------------------------------------ -- DATE_---1.-_-Lsa.------- REVIEWED _:--.REVIEWED BY------------------------------------•------------- --------------- ----•--------------------- DATE-------------........................ BUILDING PERMIT ISSUED-----------------•-4-------------------------------------------------------------------- ------------ DATE------••----•- ' Alferat' ns an or recornme,!�ations: ------------------------------------ n' -------------- __ vC - Qi . - '� ------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------•.-------------------•--------------- FINAL INSPECTION BY:--- � Date.-------•---------- �� ro �----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak STrset 124 Sycamore Street 205 West 91h Strout Stockton,California Lodi,California Manteca,California Tracy,canfornia ES 9 REV19Eb Begg YM 3.61 ATLAS