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---_-.....- G...-:/----- APPLICATION FOR SANITATION tMIT Permit No. f'l41..... � (Complete in Duplicafe( This Permit Expires 1 Year From Date Issued _._......_...-..... Data Issued ....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 County Ordinance No. 549. JOB ADDRESS AND L C<A_T-_IO ...V--- _i_..O.....�_..�.!�7�_.�..�-..i./. .�E-_flt ............ .__:.s.. .___ � T . � ____.__ ..._---.._..-.. _h.- -•-.----•--- W111Y1...--- Owner's Name.. Address.......---..__....1�G/ < .................. Pone._........_._.._.._ ......_... ____ TydN / ___ ______ Contractor's Name... 1t<< ,-l` R�t�-- ......C' s'��1.�fc S.G. ........... ................ Phone__...111._._._....1--............ Installation will serve: Residence ❑ Apartment House ❑ Commercial ile rar Court ❑ Motel ❑ Other ❑ . Number of living units: ........ Number of bedrooms ..-..... Number of baths ...._.._ Lot size .-------_............._...._..__ Water Su -••------•-------------- pply: Public system ❑ Community system ❑ Private 1�6epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[R—Hardpan ❑ Previous Application Made: (If yes,dote....................1 No Eg-- New Construction: Yes JR-`No ❑. 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 weII,A7, [0.Z?Distance rom foundation.Al-,i,_:_[2. Material... Q� irf .......- - .... tJo. of compartments..----_�-----.......Size.-�"'.,'1 . ........Liquid depth.... J.._..- ............Capacity-_• (i/_ gay Disposal Field: Distance from nearest weilM.`xS"-.'.Distance from foundation-:-.1'6,__ .'_Distance to nearest lot Iine.t:�2r:N1-' It1 Number of .................Length of each line(_VjzeG!.._.....•....Width of trench..--..._. !.! Type of filter material_:! Depth+h of filter material..--.j.�j..�---_.---Total length..........�xfr.'c2..'................. Seepage Pit: Distance to nearest well-1Lirl4. '_..Distance from foundation_(tliy/� _-.Distance to nearest lot line_.erltr_�.' Q Number of pits.--... !......__....Lining material..."t ,t.--........_Size: Diameter.yy"'__--_,._---Depth....... Cesspool: Distance from nearest well...-. _........Distance from foundation ❑❑ . - - - ............•.......... ....................Lining materia l......Size: Diameter Privy: Distance from nearest well....... - ep - - - - - Liquid Capacity--- --•.--._...---------gals. Distance to nearest lot line.. ........ .•••- ....--.......Distance from nearest building..............._...._...._........._. _...-. Remodeling and/or repairing (describe):....... .... ...•-_----.._. .-----------_.__.._ -_--._.......... .—....... -� `-------.Iteb-------------------------••--------...__..._..._.._..--------.._.---•-----•--••-------.......—,- ----------_--..------•11111111----•--------- ----� I hereby c that 1 have !ePare this application and that the work will b@ done in accordance with San Joaquin County ordinances. a laws, end sraga tions of the San Joaquin Local Health District. (Sign �e� '----- --•------ --1111- 1111-- •111111--• ................. ....------------(Owner and/or Contractor) 1111..... ........ 1111-----••------••---••------••-----•-----•- (Plot plan, showing sae of lot, location of system in relation to wells, buildings, etc, can beeplaced on reverse side).- ---------- F,�O�R DEPAR7MEN7 USE ONLY APPLICATION ACCEPTED BY-- - 7..-.-� _ --- — ....... DATE.-----•Y.l_-..s3f--.,?1...................... ' --- 1111*- -- --2 - - � r' REVIEWED BY.. ...........................------_----------- - BUILDING PERMIT ISSUED.__...................—......... - ' — ---_ DATE-----.____..____.--1111--.__.—. _-1111-----y<----•---•-- D " Alterations an /or recommendations:.......----_ -- DATE --• Tl _....-....-:.<: .L----.-..--T: �G-mac -'.e-scL •--- '--- ..,,1 .1111_...._.T _ - < 1 < _ - - !f' _ _ . � -u - -1111-- ..,�- . - - ---..... FINAL INSPECTION BY:-------- ................. Date............. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hoael/on Ave. 300 West Oak Street 124 Sycamore Street 105 Westth Street Stockton, California Lodi, California Man rata, California Tracy,California G.P.CO.