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VUKU1-1 iK-t Ust: -�=30 ------------------ ------------------------- ----------------- APPLICATION FOIA, SANITATION PERMIT Permit No. (Complete in Duplicate) �. -- ----- - This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct an• install the work herein describe . This application is mad in compliance with County Ordinance No. 549. ,, 1 fn { JOB ADDRESS OAN / CATIO ____-__C2. -0-----�4--1 -- -- �. ----- b Owner's Name__ �^rrs.�� - --•--��------- - --- -"�='�---..--- -- - - - -- -------- ----- �----------.. Phone_ -�r�..—„37 Address V. Residence - ' ............................... ------- ----------- . �/ Contractor's Na - `� Phone---W -=- T1 Installation will s { partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I__-_ er of bedrooms _.. Number of baths _1---- Lot size ......`7Q-`-�°�.�_Q__�------_--- } Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table &Q ft. ; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ " Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ N PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if blic sewer is available within 200 feet.) n Septi Tank: Distance from nearest w�,ll_ D.istaricerom f ��da -___-.___._.Material - �p # ,,_No. of compartments-.,Z4---------------Size ___� 0._X-�u d depth___ �_r�----CapacitY___�iQ6$'�. r �� p Number of lines___.-_____ g .......rom of french 9-5z -----_-�--_. Type of filter matenah ----Depth of filter material____.__ _ -------- Total length-------------------- Seepage Pit: Distance to nearest well_ Tl-e----,--Distance�m f undation___.tfAV__ __.Distanc to nearest lot line__._____,__ t1"' Number of its.__._ .__Linin t � -- Depth----- --�-------'-- '4 p� �-_.--_.._._ g material___ `�._.__ '.__ Size: Diameter. Cesspool: Distance from nearest well________________Distance `from oundation._.__- ---_._.Lining material__- ❑ Size: Diameter - --------_-Depth-- ' `----------------------Liquid Capacity------ --------------------gals.'* Privy- Distance from nearest well-__________________ !-----,__:_.____Distance from nearest building-------------------------------- ❑ i Distance to nearest lot line ----------------------- ------------------------------------------------------------------------------------ 4- Remodeling' ------------------------------ 4-Remodeling and/or repairing (describe):-----------------------b- ------- --- k------ ---------------------------------------------------------------- ._. -- r �. _ ._ ---------------------------------- -------- ----------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- I hereby certify thatave prepared this'application and that the work will be done in accordance with San Joaquin County 4 6Minances,'State laws, an,Vjtyles and regulations of the San Joaquin Local Health District. [Signed-------- or Contractor SEPTTC '[ 4NK SERVI�1~ u -- -------- --------=------------- ) g 2915E Miner Ave HO 63841 r y --- --------------------------• -------- - ----------- - .- ----------(Tide)------------------- ----------------------- (Plot plan, showing size of lot, location of system in relatio build i gs, ., can be placed on reverse side). J F- FOR D ARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -- ---�----- --r---------------------- - ------ DATE------�� - �--3 '� ------ REVI EWED BY-------------------------------- ------------------- ------ -------------------------------------•-------------------- DATE------------------------------------ BUILDING PERMIT ISSUED. ------------------ ---------------- ---------------- DATE Alterations and ecommendation � ...__ -. ------------------------------------------- - .......... - [ . rt- �Goy*-�re G�'` f � � �W r-1 �c, -- -------ate '-------- r�.�rz` ems------- ------------------ - ---- --------------------- - ---- - ---------- ----------- .......--- - ----------------------------------- -------------------------------------------- -------------------------------- -------------- l` FINAL INSPECTION BY:. r --------- Date ' . _.-� ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California