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FOR OFFICE USE: r, a �• ________ --------------------------------- _______ APPLICATION FOk-SANITATION PERMIT Permit No. __/7aZX. � ----------------------------------------- - -- --------- (Complete in Duplicate) -----------------------=--=----------------------- This Permit Expires 1 Year From Date Issued Date Issued aS� 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. f JOB ADDRESS AND LOCATION_:----- '_7a. r4r ---�1A�----��-- --------- ----------- f ��/ �`/---' --------- i Owner's Name.------4?ill-1!/�-,2��Lee-)/--------------------------M--------------------- ----------------------------------------- Phone--7 ---zleTes 0----- Address------------•--------o2-,?X�/----.-dd'/1_ot/ Z1je'� Contractor's Name------------------pLtV/7�l�----------------------------------------------------------- -------------- -------- ------ Phone----------.------------------------ Installation will serve: Residence i Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___r___ Number of bedrooms _3_ Number of baths _2;�, Lot size .__1 __________________'_____ . -4f Water Supply: Public system ❑ Community system ❑ Private Ur-IDpth to Water Table _ ft. _ 1 Character of soil to a depth of 3 feet: tSand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑Clay ❑ Adobe [g ardpan ❑ Previous Application Made: (If yes date_________________.-._) No [ New Construction: Yes Kr`No ❑ FHA/VA: Yes ❑ No B-- TYPE rTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) F , 4 a Septic T nk: Distance from nearest well-,OL from foundation --_Material-__ No. of compartments.__-___ _- ____.__Size_- x-S�x_9_--____--ILiquid depth__..��.f---------------Capacify--- R� Dispos Field: Distance from nearest well_____________----_'Distance from foundation_ __400 r.-.�- istance to nearest lot line__________ Number of fines___ Length of each line-0 � ! ` -s idth of trench-_____l __ Type of filter material s Depth of filter material M!;,,-1.f------.-..Total length--------_-2440_____________________ ' t ��s � �z;f� ► 0 Seepage Pit: Distance to nearest Well------ --------_------_Distance from foundation_____`_____________Distance to nearest lot line----------------- 11N rnjer _-____________._hNurnjer of pits--------- -----------Lining material_-_--------__-..__ ----Size: Diameter-----------------------Depth 1...----------------------------- =w , Cesspool: Distance from nearest well-----------------Distance from foundation_____-_---_----._...Lining matErial__._.i_-_______________-__________. ❑ Size: Diameter.- ------- -- -_ i 1 ) Depth # Liquid Capacity. ------------------ gals. .j I , Priv Distance from nearest well_________________{----- --------------..Distance from nearest building r0 y' 5 ------------------------------ ❑ Distance to nearest lot line-- --------------------------------------------------- Remodeling and/or repairing (desc Ibe):- -- -�'� r� ------- �------------------------- y -----------------------'---------------------------------------------------------------------------------------------------_'- 1 -----------------------------------------------L------- ------ -- 10, ------------------------------------------------------i-----------I-------------------------------------e-----•------- ----------------------------------------------------------------- --------------.......... ------------------------------------- - --------- ----------------------------- --�� I hereby certify that I have prepared this application and that the work'will'be done in accordance with Sar Joaquin County ordinances, S to laws and rules and regulatio s of a San Joaquin Local Health District. (Signed)------------- -------------------------- -------- ------------- - -- - - ---- - (Owner and/or Contractor) BY:---------------------------------------------------- - ----------------------- ------------------------------------- --------(Title)------------- --------------------I---- •�', (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- :-- I ----- ------ DATE-------- ----------------------------- --------- 6.5 REVIEWED BY )- -------------------- ---------------------------------------------- D'ATEt------------- --- BUILDING PERMIT ISSUED---- --- ----------------- ------------------------------F--------------------------- -- ------- DATE------------------------------ Al�erratt ns and/or recommendat' nsc---------- - ----- --------------------r_..._:----__ - _----� ------ --------=- .� ---- .-- --- --- - ---, vJ f -- __�� --- -- ----- ^ Aa /- 40 .. - � FINAL INSPECTION BY:. _ - --__ --=,�-. --=-�-- ---- _ Date 7 --------- - ----------------- % SAN JOA 611r LOCAL HEALTH DISTRICT ' 4r tX W''"1� Q 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California F.P.CO.