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>� rvK vrrli—t USt: `Y --------- - _ _ -�. a _ �.r Y -- APPLICATION F:6 �SAITATION PERMIT Permit No. �- -- ---- �� (Complete in Iuplicat ) This Permit Ex ices 1 Year From Date Issued 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. 549. JOB ADDRESS AND LOCATION-1//__ ._/_1.:,...__, trn�----. Qlp ! Owner's Name ----�4,'?-.7 5.......... 77_.%x' ' -- -- -------------------------_---- - -- - ------- - -------- Phone_5��_GI,S---�.�,-- Address_ .A-:2-----Z,_. qC�'1 1Q.. �� R7° �'Zo'N---- -------------------- Contractor's Name------------ `�rr';g----------- --- --------------------------- ------ -- -- --------------- Phone------ -------------------------•- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court p Motelj ❑ Other ❑ Number of living units: ._ L_ Number of bedrooms _ 3_ Number of baths..__ __ Lot size ----- --- Water Supply: Public system ❑ Community system ❑ Private Dd Depth to Water Table _94 ft Character of soil to a depth of 3 feet- Sand E] Gravel ❑ Sandy Loam X Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_._. ------- 1 NoX New Construction: Yes C8 No ❑ FHA/VA: Yes ❑ No _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__--is -.-_Distance from foundation_____!Q_ -------Material .C�m 19 No. of compartments-------_.Z------ Size--- x Liquid depth--------` Z •� Capacity._ 4 I Disposal Field: Distance from nearest well Distance Distance from foundation---- G---------Distance to nearest lot line_ _-• Number of lines _}..--------... __, ------------Lenpgth of each line--.------ 5"_,f------".Width of trench.."......Ay----------------•--- Type of filter materiai__-1��-__�-(T/--De th of filter material____-_f-g___ Total length 1j74?__`-------------------- e : Distance to nearest well__________ ---------- Distance�from foundation _____ ___._.____._Distance to nearest lot lime______..____•• �� ❑ � Number of pits... 2--------- ----Lining mate ria i_�l25 � Size: Diameter-- :-'- 7 --- Depth...... ---".Z_S i Cesspool: Dis+ante from nearest well _______________ Distance from foundation-----_-------- Lim material ❑ Size: Diameter. -- -- --- ------- --�• ---- .Depth--------------- - ---------------------------------- ell -----Li uid Ca aci Privy: Distance from nearest w __.._..___"".---""-._-_ -------gals. El Distance to nearest lot line--------- ---------------Distance from nearest buildingt .___.___.._. ---- -------------------- ------------------------- Remodeling - - Remodeling and/or repairing (describe):----_---_------_------_ _..--_._"".__""_"-_-.""_"_._"_."_____________________________ ___"__-_______"--________-.. -------------------------------------------- -------------- ------ ----------------:------------------------------------------------—------- __ ____"."-_.__.__._"..-.__""___"...__"-___"____________________________________-----------------------.--------------------------------------------------------------------------.-------- _._..___.____.-.... ..._._... .. _ I hereby certify that I have prepared this application and that the work will be done in accordance with Sa ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. n Joaquin County 5i ned - (Signed) g ] (Owner and/or Contractor) By:--------------------------------------------------- --------------....---------------------:--------------------------------------(Title)------------- --- (Plot plan, showing size of lot, location#of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._._._-__.. _".....__,__ .1L" ....... -------------------- -- DATE---h--- ---------- - EVlEWED BY. ----- BUILDING --- - - - - ----- 'i---_--- -------------•-------- ------------ -------- - - --- DATE----- BUILDING PERMIT ISSUED------------------ _-- - ----- --------- - " ------------------------- -------------------------------- ---------- --- -- ----------- ---- DATE - -- - - ------------------- Alterations and/or recommendations:.._3 - rr --I-- - --- F 2�/ ------ �J,r - - --------- --------- ------------ -- W #N �1 ------------------------- FINAL ------------------------- FINAL INSPECTION BY:..--------__--- �'��• `( /� Date_.-.. .f..-..."-r - - --------- --------------- ------- - 1. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street � 20.5 West 9th Street Stockton,California Lodi. California Manteca,California E.N.9 2M I-67 Vanguard Press - Tracy,California