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1 VI\ VI I I\.L VJL: ---------- ---------------------------------------- 'LICATION FOR SANITATION PEf T Permit No. 7.7 .._!- (Complete in Duplicate) __.-----------.---------------------------------.___ This Permit Expires 1 Year From Date Issued 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 LOCATION.. RI�-f -11O�'�? _CY T_._ _.3 ��1&eaY------ t Owner's Name------- T � ..�7.iF'�YS ,p2 U ---- �Q/- 4A Phone--¢ �--6' '�' Address---------------3_,ra�----- ..-------•--•---------•--------------------- --------•--------••----------------------------------------------- Contractor's Nanie- _'�_�/�/p /.S y__- A✓-aj-----'•---------------------------------------------•--•----•------•-------- Phone.' P�--falrr0 Installation will serve: Residence [4-- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/ .. Number of bedrooms -3--- Number of baths _Vic.__ Lot size ___------._.__.....__ Water Supply: Public system Ek-'Community system ❑ Private ❑ Depth to Water Table -12l_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [�J�Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑e New Construction: Yes E4- No ❑ FHA/VA: Yes ❑ NO [�4— TYPE OF INSTALLATION AND SPECIFICATIONS: Z (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---+_7.- Distance from foundation__fib----_.___Material-._ _�e_E-�.5j..---______- / L� No. of compartments__._...,v!5,__________-Size -- ----. Liquid depth_.' 4- ---------Capacity_/ 4®_ ( Disposal Field: Distance from nearest well__.....-------Distance from foundation__fQ____---_Di ��nce to nearest lot line__��.___ (� Number of lines__.__.._-.�.__.______Length of each line_______ .>fSpz�Wc1th of trench.Q?_�--------------------- UJ Type of filter material-_____________ - -__Depth of filter material-----------------------Total length------------------------------------------ j, oo See it: Distance to nearest well _.__.'-`__...__.Distance fr f ndation---G -------- Dist e to nearest of pits..- ----------.Lining material_S Size: Diameter--- - Depth -------- NumberT Cesspool: Distance from Barest well----- Distance from foundation. -----------------_Lining material_._..__--_-______________-_.-____-_ ❑ Size: Diameter- - - -------- -- --- -- -----.Depth- -------- -- ------------------------------------Liquid Capacity----------------------------galS. Privy: Distance from nearest well-----_______----------------------- ---_-------_Distance from nearest building----------------------------------------- f_1 Distance to nearest lot line -- --------------- --------------- _-------------- ------------------------------------------------------------•------•------- d Remodeling and/or repairing (describe):------AIZ:4C--)------- �GK.577`4!5--------------------•-------•---------------------------------------- 3V ---------------•-------•-------•--------- ----------------------•--------•--------------------------------•-----------------------�--------•---•-------------------------------------- .....--=--.................--------- - -----------------------------------------------------------------•-----------------------------------------------------•-•-----------------------------------...........................................................-- ----------------------- ----------------------------------------------------•-------------•----------------------------------------•-----------------------------------------------------------------------•------- --------- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a aws, a d rules and regulations of the San Joaquin Local Health District. (Signed)------------------------� -------�._S. ---- �� ------------------ --- - (O ner and/or Contractor) By:--------- G� -- -�- ------------- ------------------------------------(Title)----& --------... (Plot plan, showing size of lot, locat' n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---?l' --.----- ----•------- ---------- --- -------------- ------------------------- DATE__-_t-:../-T- .. _11 `------------------- REVIEWEDBY----------------------•-------------------------------------- --------------------------------------------------------------- DATE----------------- --------------------------------------_--- BUILDINGPERMIT ISSUED--------------------------------------- -------- ------ DATE.-------------------------------- -------------------------- Alterations and/or recommendations:./-/3...'(,5--------- .._._ . c�-- ------%+/-..�.---�cE�ssr- ------------•r•--•- ---------.Lt��z �c s� � �-�----' `u 'L`.. ----- . ----.... �" �`¢ ,�z�i�,..,Yo ------ ------- Q--------------------------- ------ --------- ----------------- -------- - - --- -- ------------------- ---- -- ---- ------------------------- -------------------------------------------------------------- -- --- -------- -- ----- FINAL INSPECTION BY: �<�1 .__`C� _ 12 ....-- _ Date_.. ` _. ,__-_ 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 F.P.CC.