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FOR OFFICE USE: may, ---------------- ------- -------------------- p-_ APPLICATION POR SANITATION PERMIT Permit No. ------------- "°" (Complete in Duplicate) ..' -..'�.' ---_ ___ --------------------------- .... _:_.,.: `� This Permit Ex ne's 1 Year From Date Issued Date Issued Application is hereby made to the San oaquin Local,Health District for a permit to construct and install the work herein described. This application is made in compliance with CountyY Ordinance No. 549. .y . JOB ADDRESS AND LOCATION.... 3 ` ` `�! fl , �,------- ------------"---- ---------------------------------------------- Owner's Name '-am C� - "``- -- Phone— � Address ,• ---------- `------ •�I`- - ----•-----------"•--------------------------•- � - 1 Contractor's Name 4 ` ----------------- Phone------- -••-------- Installation will serve: Residence*[ partment House ❑ Commercial E] Trailer-,Court".[] Motel ❑ Other ❑ Number of living unit , `__ Number of bedrooms-.- Number cf baths "_-----L-ot size _ a _ _� __ _ __ Water Supply: Public system ❑ Community system ❑ Private Depth to.Water Tablet,LS:ft. :tk- Character of soil to a dph of 3 feet: Sand ❑ Gravel ❑t',Sandy Loam El-. Clay Laam ❑! Clay 0 Adobe Hardpan ❑ - 4 Previous Application,Made: (If yes,date...+_.__,-.__..._.._ ) No m New ConstructionYe`'s.,V No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No se t c`tank or cesspool permitted if public sewer is available within 200 feet.) 'I., 1� Septic nk: Distance from nearest well--_w _ _._._Distance from foundation-_t _}.__ fvlaterial--:- . T`7C--�CA- No. of compartments___-- --. ......__Size__' XJ.11 ----Liquid depth --"V-/--- _..,__Capacityl V41 Dispos Field: Distance from neareswefL— Distance from foundation_`':_��:�1`-.0 .: Distance to nearest lot line... N Number of lines--------�j----.-- --------`-_ ----Length of each lia r _ x � m hof trench--------�-�------------------ W- j fType of filter material'a I, , Depth of filter material--__-- --___.'.:.- otal length--_.--___-_ - -- _-_- W _Seepage Pit: Distance to nearest well----------------------Distance from foundation___=:: :Distance to nearest lot-line__.__._________:_ - - De th- p �= Cess ool: D•stance from well- Linin material from foundation materiel=:_.__..._^ 1` ❑ p� - g - - P ❑ Size: Diameter-------------------- ---Depth------- -- ---------------------- -------- .- -Li uid`Ca acit ,---------------------- ' r_ .. q p Y ----gals. Priv Distance from nearest well--------------------------------------------------Distance' from nearest buif&n � -.----------..-.-- _ ❑Y ` ------------------------ ----------------------------- -------------------------------------------------- ;. Distance to nearest lot line_______._.__ Remodeling and/or repairing (describe):---Ani-le- - - i--i--c r}�+ h P/ ] . --------- ------ ---- I -----------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- ------------- -------------- ------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------:----------------------------------------------- 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 Healtk District. (Signed) "''----- - ---------------------------------------- ----------------------------------------- By:- ..----- ---------=-- - (Owner and/or Contractor) BY --------------- ---------------------- ---------------:------- (Plot --- '��itle) : ----- •---•--• (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed-'on--reverse side). I FOUR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- _ -------------------- ---- -- -- -- ------------- - DATE------- �r -------------------- REVIEWED ----------------REVIEWED BY----------------------- ------------------------ DATE------- --------------•------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------- -------------- DATE.------------------------- ------------ y.,-----Q----- -- Alteration's and/or recommend ations:---fc_'._t_"_.� -------- ----_.___ �7------- - _---_- Al PAC --- ------- ----------------------- - ----------------- ---- ------------------------- ------------- --- ------� , ------- -A,7� - c -o � Ems' FINAL INSPECTION BY--- -------- ---- CP-------- --------------- ------------ Date--------(' LQ�� -------------------------------------------- SAN ------------SAN JOAQUIN LOCAL-HEALTH DISTRICT 1601 E.Hazeiton Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street i SleMon,California Lodi,California Manteca,California Tracy,California r `� f { t F.P.CO. rF�-