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FUROFHCE USE: --------------------------------------------------------- 93 APPLICATION"FOR-SANITATION PERMIT Permit No. __62--JZ--------- ---- ----------------------------- ---- ----------------- (Complete in Duplicate) / ------ ------------------------------ This Permit Ex ires 'I 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 com.. .lianc with County Ordinance No. 549. Z �U—!l JOB ADDRESS AND LOCATIpY_® ------ I----------- ------. u7T- =-R ST- -------------------rwTEcA Owner's Name--------------------------LUQ W t C----------- ------- - ---- ---------------------- ---------------- Phone-------------------------------•--- Address._..... �� ---------�------- 5 � - ------------ ---�. ------------- --•-------------------------------------------••-•--------------------------------- Contractor's Name----------0W_N&-T1_1------------------------------------------------ -------- -------------------------------------------- Phone--------------------------------- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .----- Number of bedrooms. Number of baths j--- Lot size ..-� - -- Water Supply: Public system 2--c'ommunity system ❑ Private ❑ Depth to Water Table ft. ~ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [ 7j� Previous Application Made: {If yes date.__...__..__.._....} No New Construction: Yes �No ❑ FHA/VA: Yes ❑ No 2i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.). Setic ank: Distance from nearest wekl.._�_.V�!_Distance from foundation---1 ---------MateriaL..CQ/__�CRE� p 3 , I No. of compartments....___Z_.___._.__Size___..x_�.�___�.•...Liquid depth....��_.._Capacity....__ Is. --- Disposal Field: Distance from nearest well.•_______-__ Distance from foundation---._4Q.---____.Distance to nearest lot ling......... �}— I} Number of lines----------- Length of each line_�_d__6©-_-__.Width of trench.---- r Type of filter material---RO_CK__.Depth of filter material -_1__ g S . ------Total length ----- �-------- -- -Seepage.'Pit: Distance to nearest well----------------------Distance from foundation---------------.__- Distance to nearest lot line__--_.._--Number of pits.---- Lining material-----------------------Size: Diameter-----------------------Depth_......--------------.----Cesspool: Distance from nearest well-----------------Distance from foundation-_---__._.-.-......Lining material-------..-----..-.- --..------El l' Size: Diameter- ------------------------------------De th---------------_------------------------------------Li uid Ca acit __ Privy: Is Distance from nearest wel!----- --------------_----------_.Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------- ----- - JT1 L --------------------------- l2emodefing and/or repairing (describe):...�� P A.I�E ---�40-.------P R.0 ID -._--� _.-._-�Z_�-..--�1_s __- O-R ' F'IRS_-------�nl��.---- �9T N11.r N -----��-^°1 I�21 f _ rH 1- G'Q_�iN .r T` -------- C.1IT-��---- 5_ vt1 _i3 t----- _�4_t t< �t- S PTI C=------�N r . �4I l4_r.1 b O cel ------Lf—:4c-0--F_t_r__A_s?.e--------------- -------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ----------- -----¢---,- -- ---------------------- ------------------------ ------------------------------------------------- -----------(Owner and/or Contractor) By?-L�.�LC-------- -------- - - ---------------------------------------------------------------------------------------(Title)--------------------------- (Plot plan', showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------—rA--.R ----- -------------------------------------------------------------- -- ------------ DATE-----..- --------------- REVIEWED BY------------------------------------ ------------ --------------------------- ------------- --------------------------------- DATE----------------------------------------- ------------------ BUILDING PERMIT ISSUED----------------------------------- ------ ------ -----------•------------------------------------- DATE--- --------------------------------------------------------- Alterations and/or recommendations:----------- -------------------------------------------------------------------------------------------------------------------- - ---------------- ----------I------------------------------------- ---------------------------------------------------------------------- --------------------- ----------------------------------------------------------------- ------- ---------- ------------------ ----------------- ------------------------------------- .............. --------- f,� i ---------------- ------------------------------/.. J-- ------------ ---------------------------- FINAL INSPEC N B ------ Date-------- lO~ ✓ � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Norelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California t Manteca,California Tracy,California