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FOR OFFICE USE: 6S`------------------------ ------ ----- ---- -------3A6 `__._._----_---_--.._..3.p_6APPLICATION FOR SANITATION PERMIT Permit No. -__Z��--- ---------------------------------------------- - ------- (Complete in Duplicate) Date Issued ' --.--- This Permit Expires 1 Year From Date Issued - - j 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. iJOB ADDRESS AND LOCaN__ _.-----_ R QY-- es`/_._____��( / f - Owner's Name--------- -- - -------------------•----------•---- ----------- ------- - Phone-------------------------------- Address----------------------- Contractor's Name ------------------------------------- ----------------------------------------- Phone----------------------------------- Installation will serve: Residence [—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: _-i---__ Number of bedrooms -,3-- Number of baths -.3__ Lot size Water Supply: Public system ❑ Community system ❑ Private �pfh to Water Table - ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,Idate- ---- --------) No dew Construction: Yes 6;j�o ❑ FHA/VA: Yes 5;.w--ltfo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic TPA DistanCB from nearest well_' 7__Distance from foundation----ID--�---- Material_.CL,__. __r/_c_I"-....... r. No. of compartments....r3 -------------Size, _.SM_/Q-___Liquid depth-------- --- -------Capacity-I.-A-4710_.___ I Disposal F' Id: Distance from nearest well..10'0__1_Distance from foundation___-" f...-Distance to nearest lot line_-`f_____ Number of lines ___._I_-------� p Length of each line___7s�__ ' __-Width of trench_.p1__y_��_"_______________"" Type of filter material_-- .fZ_/� '"Depth of filter material____._�d'��.___--Total length--- _______________________ N S-- / V l-6 Seepage Distance to nearest well-.--- 0-- _ Distance,from."' __ ---d _oundation - Distance to nearest lot line_"._"."___.-___-- s Number of ------ Lining material----��f t.> -------Size: ete Dia_�nr.__ ,�..��".___. e th ....E - D - - p rj.rv----,/--'------- Cesspool: Distance from nearest well----------------- from foundation....----------------Lining material-___._._.___-._____._______---_-----. �7 ❑ Size: Diameter-- ----------------------------- ---Depth------------------------------ Liquid Capacity gals. Privy: Distance from nearest well------------------------------------------------- from nearest,building__-------------------------- ❑ Distance to nearest lot lir6------------------ --- �.'!_-. 'l € Remodeling and/or repairing (describe):---------------- - .1 bF� 45. - 11 1 - - ------------V----- I hereby certify that'1 have prepared this application and that the work will be done in acc_orc#'ance with San Joaquin County ordinances, State laws, an ules and regula ' s of the San Joaquin Locel Health District, t~ j —i (Signed] = /-a' d ---- (Owner and/or Contractor) By---------------------------------- Y" ---------------------------------- ..Lipp.(Tifle _. r ] J- -----.- ------ (Plot plan. showing size of jot, tion of system in relation to we ls, .buildings,4etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-- -- ------------- DATE - REVIEWED -- "-------------------- ---, -------"----- REVIEWED BY ---------------- `-------------- DATE-------------- _ BUILDING PERMIT ISSUED------------- DATE--------------------- t=- --------- ------- Alterat'ons and/or recomrnen ations:"-- Q------> ------------Ctr s ----------j�.p�['.1C..----��C/ t�-------------------- ------ ------ --- ---- - -- Ak9-------------- 1 _.``TA--4.__�.7'------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------- ----------------- ,;7------ -• ------------ -------------------------------------------------------------- ----------- ------------------------------------ ------ ----------------------------- - FINAL INSPECTION BY:.; 11 -L�!C -- ------ Date--.,- `.� `�-- SAN JOA QUIN LOCAL HEALTH DISTRICT 1601 E.Fla:ol+on Ave. ? 300 West-Oak Sf er et B 124(Sycamore Street t 205 West 9th Street f Stockton,California Lodi,California t Manteca,californin-# Tracy,California