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AP LICATION FOR SANITATION PEROe Permit No. z�C csf� .._........-- . --------------------- (Complete in Duplicate) Date Issued .�_._=-_:-✓...'6-�0 This Permit Expires 1 Year From Date Issued 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, JOB ADDRESS AND LOCATIO/N._./I -- `i_rL1__-_��I!/��----/ .--- -11.'rl�P----S✓---� 1°l1i<.�_ � .R.li> Owner's Name--------- �,2.... ..'.-_--_------------- ---- Phone--------------------------'-'---- Address------ / yd --/IL---------� dfsf�__ -- ----- ...............- ------------------- - -------------------------------------------------- Contractor's Name------------/f4il... / -------_'.------------`---------------------"-------------`- Phone-- -_- Installation will serve: Residence P,"Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .. Number of living units: Z_- Number of bedrooms �� -.. Number of baths -/__ Lot size _.`Z,0(_OFA�fe__-- ------------------------- Water Supply: Public system ❑ Community system EIPrivate 2rDepth to Water Table 4549_It. 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 g?"` New Construction: Yes Z?�'fJo ❑ FHA/VA: Yes R5-�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic TO: Distance from nearest well---47-----DistaA . ...Ma_t�e �I .6to5- -,�x __--- Capacity-".of compartments----r --_______-SiX-Irl1_g_Liquid depth_ . . LDisposal Field: Distance from nearest welll�__. .Distance from foundation_. 1F..____-.Distance to nearest lot line_3 - -_.--. Number of lines----__-- --__T---- -_-_._ Length of each line--__--- l/ g 7 � Width of trench- -----------------__.. .. L Type of filter material�g $e-_-Depth of filter maferial_.l .......__.=Total length---- L -._.._...._.. � Seepage Pit: Distance to nearest well_- Distance ,f�'^rn fo dation_ li.�_ _ __.: isnce to nearest lot lir�/ as-------------- Number of pits-----/__-_--__-_Lining material--AGt�/* y-n_-Size: _Dianne ter.-___-_Depfh.'A--..f-- --- ---l--..Xr LCesspool- Distance from nearest well Distance from foundation __-_ _Going material --_ -.. -_-. L ❑ Size: Diameter. . .----------------- ------ Depth-------- ----------------------------------------Liquid Capacity---.....I------------------gals. Privy: Distance from nearest well Distance from nearest building ❑ Distance to nearest lot line-------------------------------- ---'--- `---- V Remodeling and/or repairing (describe):- '/.-�. ra� --- -' ----- ------ - ----------------------- ----- ---- - --------•-- ------------- - f-- ------ ----------- _j - - - - ------- -------------- ------------ - ----------------------------------------------.A.---------------- -------------------------------------------------------------------------------------------------------------------- - - ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r gulf tions of the San J''agqu�uinn Local Health District. ($igned)_.__-_-__.--_____----__--.__..-_ .--- f .-- --_- __( or Contractor) ----- - _..._._-__--...-...._..-._ /� By:-------_--------------------_------------------------- ------ ={� ` -`-------.._(Title)-Ql��I��L-' - - - (Plot plan, showing size of lot, location of system i ration to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY -------------- ---------- ------------------- ------ -- . . DATE-----------------------------------_ --- REVIEWEDBY------------------------------------------- ------------------- -------------___------- . ''- . . DATE-------------------------------------------- PERMITISSUED-----------------------------------------------------................................... DATE------------------------------------------ -- Alterations and/or recommendations------ ---------------------------------------------------------....___---------------------- ........_------ -------------------------------------'_----......------- ......-- ------------------------. ------------------------ ----------- -------------_-- . - -------`------_.------- -------- -- -------- --- -_--------------._..-.._.-. FINAL INSPECTION BY:-------"- - Date ........... C -- --------- ----- - --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hocelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Ladi,California Manteca,California Tracy,California f.P.CO.