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ION _ FOV.OFNCE USE: ..... _ APPLICATION FOR SANITATION PERMIT Permit No. yr // 11. . .. --- - --- (Complete-in Duplicate) Date Issued /!!��.G.7 --- - .-- ----. . . -_. .. 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. C S STE V E_N %_O N t�A: JOB ADDRESS A(jy7p I,OCATION....._� _' .--_...........-.............. .........._....................._.......... Owner's NemS.....j/`0..a_Q.W1.._.. �- � ._ ._ ..__...................__.._._. Phone- .4.3.'-.J_�.:T_a... --•---r�.....1._-.e..11.. .^l yt 0.. ... ... ....-----------_.._------------------_.- ----'----.------------------------- r �+ Contractor's Name......_ _ .�..c..:........................ Phone........................-....._. Installation will serve: Residence (Apartment House ❑ Commercial 2_�Treiler Court ❑ Motel ❑ Other ❑ Number of living units: ....... Number of bedrooms.2... Number of baths .�:... Lot size .•..I_. .._. ..Y._S$................... Water Supply: Public system [I Community system ❑ Private Depth to Water Tablcb.i;n. it Character of soil to a depth of 3 feet- Sand❑ Gravel❑ Sandy Loam❑ Clay Loam Clay❑ .Adobe❑ Hardpan❑ Previous Appli afion Made: hf yes,date_.. .... .... ... I No @a-- New Construction: Yes Ea�lNo ❑ FHA/VA:Yes C] NO ff` TYPE OF INSTALLATION AND SPECIFICATIONS: Septic Tank: of of compartments wells./_ --.Distance fr m fo`uu-ndation_��............._ ateripl_...... .h,Y...c�Q..._........ (No septic tan or cesspool permitted if public sewer is available within 200 feet.) P 0 r 0 L{j_l,!�aCa aciT Disposal Field. Distancc from nearest well.I..TO.....Distance from foundation..!!.........:.)...Distance to nearest lot Number of lines........-.1.......-'_`..:. -.Length of each line..._... ... .l�C � Width of trench....?�'f............ ` Type of filter material..... LL." ..�Kt,pth of filter material.... Totul length_..11/4. _-I'...t,.._�..._...... (� Seepage Pit: Distance to nearest well.X-OQ,.__-_,_,Distance from foundation...1F. Dsta�nce to nearest lot line... ..T_..... .............y.� � C1a/ Number of-pds....'........_...Linicg material...�!�.!.L1 .. Sire: Diameter.'... -'�i-.�rD'1/o1,( �d �r j! _ Cesspool: Distance from nearest ell........ Distance from foundation.. _......._. Lining matena-..__........................�. ❑ Size: Diameter... .......__... ..............Depth...._....._.. ..........._._. .........._....Liquid Capacity............................gals. Privy: Distance from nearest well.. _.__..._......__..... .._._._. .Distance from nearest building..._..................................... ❑ Distance to nearest lot line__....._.... ....... .. . ................................._.._-......._.------------.._-------......_....... ..... r ` Remodeling and/or repairing (describe):-.. ...._..._ _. .._........._......-..................-......_...............___.............._..........................__.... ._.. .............................._._....................._...............-_.....-...................................................---........._........._...._.................._.........................-`...-... ...................__...................................................................................................................._..............................__.....................................-. - r .. ................ _... . .. ... ..._...._...... ...........................___ ............. .. ........_............................. _.. I hereby certify that 1 have prepared this application and that he work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ... �- 'F �-- - - -- - - (Owner and/or Contractor By:.... ... ......... ... .. .... ... ._ ..........-.._. . _ ..._.................. ..... (T41e).. (Plot plan, Aowif.g size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Bow?. Z4-c'-.Tr----<^ -_- .............. DATE/ -2.-A_2 ... ... . .. ...... REVIEWEDBY.............. ..... _. ... .. _....... -..� ._... . DATE..... _. ...... ......................... rBUILDING PERMIT ISSUED--------......... ....._.. ._.. _.._._................_................___..._ ..._.... DATE.._........_......._..__........._--........_........ Alterationsam:/or reco— ndations:_. ..... ... . _ _ ..........._ ............. ..._.............__..._............................._................. ............. ....... .............. ....................._......_......................_.................... ......... ..._._._................................................................... ...._ ........... . ___.... ..._. _. _ .. ... ........ . . ... ...... ....................... .............._. ... ...................._.... .. .... . .... .. .JI _.... ... ....... ... .. . .... ..... ..... .. ....-.... ........ ......................... . _nn lf�.�1 ry FINAL INSPECTION By:. .._. !r (.//' .'� .. Da to (r'�' .I``� _ .. ._ ............... i( _I SA/H�C:Al$UIN LOCAL HEALTH DISTRICT 1001 !.Nmdbn Arr. 300 Way OaY fi.of 134 fywMaro Anoi 305 Wirt 41a firetl Lodoeq California Lodi California Manteca.California Tracy.Colifomia ` f M.i 1M 1 •` Van�r..p'tl nrrrr