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F R OFFICE USE ? 3 ' - - � , - AFS �ICATION- FOR SANITATION PERK=.. Permit No. - - --------------------- -------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per it to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. ! fs7,L6_ 02//fk1---S7- ----`S/HE--•-o--f�T------- E/=?----j2-�.- ----- JOB ADDRESS AND LOCATION-` TNI11 ", Cf= Ali- ---- -- f ------------------- Phone-. .----••-------•............. Owner's Name------- AtC_! ---------- Address - Address---------•------- ....... ---------------------_---------------�-r-•RDEa------•-------------------•----•--------------------------------------- 3 l -Z Contractors Name-------- 5-��---------•------------------------------------ Phone.. -'--- � Installation will serve: Residence ❑ Apartment House Fr❑ Trailer,,Court ❑ Motel ❑ Other W M-P tt. R I�Cf2S Number of living units: A-,-- Number of bedrooms ..�--_._ Number of baths ._1-_._ Lot size -------`... '--- .. .................................. Water Supply: Public system ❑ Community system ❑ Private D� Depth to Water Table _4.a ft. I Character of soil fo a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan tRr Previous Application Made: (if yes,date.-- ----- No'P New Construction: Yes ev No E] 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..1E-qr-----.Distance from foundation----Ip----------Mate rial_-Z l �4 gyic( No. of compartments-----------72�---------Size-;7..e_sS.-X_`_1------------Liquid depth_----`1--s —.----------Capacity----OC_ -91j Disposal Field: Distance from nearest well----[Po.'_.._.Distance from foundation....1!P'......--Distance to nearest loft line-__`a-..f....... fi Number of lines-------------1---------------------Length of each line..------'�:Q--------------.Width of trench---------.--2_94,v.----_...--- S Type of filter material_,S.- tom --_.Depth of filter material-------i.k_"-----_--Total length_----------------_.----_-- ....._ V+ Seepage Pit:F Distance to nearest well_.._.L..Q'---__.__=Distance from foundation--_-t. ...._._.Distance to nearest lot line----------------- 1 'A �ctA Number of pits------- _--___-__._Lin!ng::,mate rial_ .a_ '-k_-.Size: Diameter--------L3s3._._..__Depth-------------�---.--------- Cesspool: Distance from'nearest well------------ from foundation--------------------Lining material------------------------..-..--_---. or171 Size: Diameter------------------------------------- Dept --------------Liquid Capacity_.--------------------••--gals. Privy: Distance from nearest well---------------- --- ---- ----------------------Distance from nearest building---.---...-._-__----.._---.-.--.._------- , ❑ Distance to nearest lot line---------------------------------------=------------------ ---------------------------<------------------------------------------------- Remodeling and/or repairing (describe):-------1_6X6TIRL G-7'` _.*� _ fir' . / -------------------------------------------------------------------- --- •--•-------•-------------------------- -_--------------•-------- - ---------------------•--••--------------------••------------------------•-•--•------.........------------------------ -•------------ 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)------------ -------- ]Ow er and/or Contractor] (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------%----- -----------------------------_1------------------------- •-------- DATE -i f-H-----•----------------------- REVIEWEDBY---------------------------------------------- ----------------------------------------------------------------------------• DATE---------------•---•••-------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------- -•------------------------------------•---------------- DATE------------------------------------.-_---------_--------- Alterations nd ,or recommendations:--------------------- .._... ----.----- �r --' ,�.._ � --------- � 1-' ------------------•----------------------------•---... ----------L----------------------- " ------------------ - -------------- --•------------------------------------------------------------------------ - -------- --------------------------------- FINAL^INSPECTION BY-------------- 10-0-------------------------------- Date--------' --------- ------------------------- SAN ---------- - • - SAN JOAQUIN LOCAL HEALTH-DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Ri'•'