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- ------ --- - --- - - - r� � ` ) res __.- - __ __....... -. . ..__-.-.... A LIGATION FOR SANITATION PERM Permit No. -.d..=T_L-.�`5 ....... - --------- --- - (Complete in Duplicate) -----------------_ _- This Permit Expires I Year From Date Issued Date Issued --- 10 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w9wierein described This application is made in compliance with County Ordinance No. 549. 01 T � / JOB seeADDRESS AND LOCAlIONs �'--/-- -- - y�--- ` �tf/-_ ee /�fl �L Owner's Name.y_.. Q 9 frp If'._..z/ :. ------- -------------------*- ------------------...--------- Phone------------------------------------ AddressSJG.� -----------------------------------------------------------`-------------- ` Contractor's Name----------_/*_I!Gi-----/L�' ---.1r----'----------- -------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial [ITrailer Court ❑ Motel [-] Other El_ Number of living units: Al.__ Number of bedrooms A--. Number of baths .--- Lot size �++��s,l7r.... %'_....._.__....------- — Water Supply: Public system ❑ Community system I-] PrivateDepth to Water Table 43'6 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam VO�Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 'New Construction: Yes 9�1 �o ❑ FHA/VA: Yes F�- 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 w II_dV____ Dista ce from f ndation-_/a--.._._.-Mate ' IfQ4� r _� 99 ------------- ®� No. of compartments. _ ___�_.y..__---- size�l� _'. %2.Liquid depth__f� _..._.___.Capacitye.�__. ._...- Disposal Field: Distance from nearest well 1'0 Distance from founda�jtion._��__._.__.Distance to nearest lot line._-._.. e Number of lines.__..._...-_ ngth of each line.f��_. Width of trench' --I.__._ - ------ 1___._.._..__......_ Number of rtare ___ell- material_ teriaLyl�__J_Tost lengthneareest l__�:______._._....-------- Seepage ..._ Typ Seepage Pit: Distance to nearest well- dation__lQ_.._...Distance to nearest lot _...__� r e e filter mate -I--- --- - g e th of u��X/� !' ___Distance fr fo ! Fxl� ��jj -Size: Diameter. epth..cec._-.________________ Cesspool: - Distance from nearesf well ... .Distance-from foundation-_----------------Linin4material---- ❑ Size: Diametersee _ _.__ - .Depth .-. ._.__ --_- Liquid Capacity_... _.....gals.\ Privy: - Distance from nearest well _. Distance from nearest building ❑ Distance to nearest lot line......... .... /-- -------- ---------------------------------`--'---------'----...._------------------------ w Remodeling and/or repairing (describe):---_---.. - :L}fh'_.-,��Q_ �f__-- r -- - - ------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- ----- - -- 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. (Si ned 9 )--------- ---- - - - - .. Contractor By`---------------------------------------- - -- - -- - --s -- (Title). - - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 6 - - - ------ --------- ---------------------- -- ------------------- DATE.......... oxJ-(o') _ REVIEWED BY. ------ ---------------------.......------------------------------------------------------ DATE_------_----------------------------------------- BUILDING PERMIT ISSUE .... -------------- --------------------------------------------------------- DATE----'-------'----------------------------------------...-- Alterations and/or recommendations:----------------------- -- .. .... -- ------------------------------------------------- ---------------- ---------- -------------- ------------ :: : :. :::: : - f------------:---------------------::::.::::: .... .. --. �. . . . _.... . ..- ---- ------- --------- ------ FINAL INSPECTI BY G ...---. .. Date ___ /__�� ------------ see N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ifaxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California _