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ru,--urr---cuac: ..aT JgaO3 - -. - A.eLICATION FOR SANITATION PEI Permit No. l 1 ..-- - ........... ------------------------------------ -- (Complete in Duplicate) Date Issued ..__ --------------------------.................. This Permit Expires 1 Year From Date Issued .............C. .L� 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 with County Ordinance No. 549. !.ff I I' PoL JOB ADDRESS AND L�O-CSA-TION.W -ENTD�- .. RCt��AP T - D-----�_-- ... :-��- �� LV-E - Owner's Name--------------- -1.C�-QQ- --------.-Rt.x��R-...... -�/- _'._._ ...............-------------------- Phone---...... _...... ... - - AddreSs.--_.157.Y].......F------ .- .-A____b------5'Z..............SAN_Lff 4.N.t?RC?7--------CALI.F: -------------------------------------- Contractor's Name...._ ..L:IiAZ-ti.- ..-..............................-................................--------------- -- -- .... Phone..................._......_...... Installation VB serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Q-I'Motel ❑ Other ❑ Number of living units: AV- Number of bedrooms ........ Number of baths -------- Lot size ..��1-_f/�_t�r ��------.............___-__ Water Supply: Public system El Community system El Private �epth to Water Table ..2.y_ ft. Character of soil to a depth of 3 feet: Sand eGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------- ------------) No [D� New Construction: Yes BNo ❑ FHA/VA: Yes ❑ No Q- 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._._SO.—-Distance from foundation.....__.-..Material-Ll- -----.-_-_-- 4E No. of compartments_.-__--.`7...-----------_Size-_5__X...1-?�...K-G-Liquid depth_._..57 - ---------Capacity----:3C Disposal Field: Distance from nearest well ...50----Distance from foundation.....10........Distance to nearest lot linei ?� Number of lines.._.._.---2-----------------Length of each ----Width of french..... Fr - -j-------- Type of filter material---�QCK---Depth of filter material___l�.-._----._Total Seepage Pit: Distance to nearest well......................Distance from foundation...............-...Distance to nearest.lot line..._...YR;e-. ❑ Number of pits----------------------Lining material.......... ------------Size: Diameter-------------._-----Depth.-----------------------------.- � Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.-.._-._--_...................... ❑ Size: Diameter.._-----------------------......Depth......---------------------------------------------Liquid Capacity............................gals. M Privy: Distance from nearest well......-----------------------------------.-----.Distance from nearest building-----------.._.__.....---_---_.----_. ❑ Distance to nearest lot line------------------.-------._ ---------------- ........................_.....------- ----------------................................ Remodeling and/or repairing (describe):.___.f FA H---__41/KF..... lN.r..--.--1.. ____ .[.V -R----.<;A.SRA V '--.__-.__- - - — -...... --------. -_.... ---- - --------------------- ---- ------ ---------.--------- .--..._T.1'3:..0 ........... ....-..... ._ reby certify that I have prepared this application and that the stork will be done in accordance with San Joaquin County tIinance$, State laws and rule�egulations f the San Joaquin Local Health District. ied)---i ---+---- I- --�---------- ------ - I ---- ----....._---.....------------------- .....................-...----------(Owner and/or Contractor) Title t plan, showing size of lot, location of system in relation +o wells, builds s, etc., can be placed on reverse side). FOR DEPA USE ONLY / APPLICATION ACCEPTED BY__.. �- -..--Q.---.... -------------------- - - -. ----........... DATE---------5'L�---6. ---------- REVIEWEDBY........_.......---------------------------_-----------------...............--------- ................--- .... DATE-------------------------------------------------.. BUILDINGPERMIT ISSUED.............................................................. --.......................... ---- - DATE------------------------------------ ---_--.-.... Altera+ions and/or recommendations:-----------------------------------------------------------------......... ............... ----------------•-------------------------------- - ---------------------- ---- ....................... .........................................---------------------------------- ..............................--..... ........................ --..-..-.... - -.....-----...............................------------------------------------.............. ------------- -------_- - ........- --- -- - - - - - - - -- - ---- _ --------------------------------_---------.................................. ...---...... -.... ......_----- ---------- -- ----- - -------- -- - - - -- - - FINAL INSP �1...-- ....... ._. Date ------ ------0-�f/ - -......---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West Itch Street Stockton, California - Lodi, California Manteca,California Tracy,California F,a.CC.