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.,,-••---t../- '1--.-b-j.._........... APPLICATIQ I'04 SANITATION PERMIT Permit No. .:. .1 >% ...... ........................... . .. ......... (Complete in Duplicate) ............. .... ....... This Permit Expires 1 Year From Date Issued Date Issued ^Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work hereidescribed, } This application is made in comelie ce with County Ordinance No. S49. ZFlT1"} RQ JOB ADDRESS AND LOCAT rlo1:--- 1W•� •. / �4 ........FRONTR-6E...... ....0 F....C��1 Owners Name.................. Phone.................................... l ................................................................. .....: .. ` Address. ' ` .1..__.-` .GU.X ......................................................... Contractors Name..._ .. it.l. .._._..P1Z_ :C,1 . ......... Phone............................. ............................................ --•--- Installation will serve: i Residence G4,-Apartment House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ Other ❑ l Number of living units: --J.. Number of bedrooms _ Number of baths __,�--. Lot size ..._.1.�_�___3�-•`�., ,-.•-_-____ _ Water Supply: Public system ❑ Community system ❑ Private 2"*6,pth to Water Table 15, ft. Character of soil to 3 4depth of 3 feet: Sand U�' Gravel El Sandy Loam F] Clay Loam El Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................} %4Er New Construction: Yes 2-14o ❑ FHA/VA: Yes 200""No ❑ TYPE OF_INSTALLATON AND_SPECIE.I.CAVQN.Si., (No septic tank or cesspool permitted if public sewnr"A a'y'�tla6le witrin 200 feet.} " PR��ST. Septic Tank: Distance from nearest well...S.c-..---Dstonce from foundation.../d_.........Material.... =- Q/l��rE E UKNo. of compartments....-2:-..............Size.yx.IlO..K-.S,----Liquid de'pth..3f/i...........Cap acity-_12.0.Q.. .�_ Disposal Field: Distance from nearest well.. L.Q....Distance from foundation__/._[?...........Distance to nearest lot line..._....._.. Number of lines.......... ....--------- Length of each line....... Q--•..........Width of french........ . '• Tye of filter material_--ROeC.ir.�. .•.Depth of filter material.....J.'7.. .........Total length_'........ ......................... Seepage Pit: Distance to nearest dell......................Distance from foundation..........._:.......Distance to nearest lot line................. ❑ Number of pits.......................Lining material.......................Size: Diameter.............. ........ Depth................................. c� Cesspool: Distance from nearest well................Distance from foundation.'-----------------Lining material................................... ❑ Size: Diameter......................................Depth----------------------------------------------------Liquid ,Capac'ity..----............ gals. Priv ": ..__..__.. Privy: Distance • from nearest well.................. .:............................Distance from nearest buildin - ❑ Distance to nearest lot line,.......................... :...._ . �O Remodeling and/or repairing (describe):............................... t -----------------------------------------------------*------•--•------ .*-------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rules atrd�regulations of the San Joaquin Local Health District. (Signed)..--- :-•'• -�... .�. -� - ti :t.t:.i�:-.... --- - , . �r •- "................. :.....(Owner end/oF Contractor) !t.L.,� I� rte :..... (Plot plan, showing size of fat, location of system in relatiot t� to wells, buildings, etc., can be placed on reveise side). FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY....... f-.I� .Q.:.". ................. - . DATE 3.�.�. .- �..... REVIEWEDBY-..-. .............................•.--.. - ;.... :..................I.-•----...-•------..... DATE..................................... BUILDING PERMIT ISSUED.......................................................... --------------------------------------- DATE....._,.'__..._. Alterations and/or recommendations........................ ............................. .......:.............. ................................--........................... ---......................... FINAL INSPECTION BYrr,-/./. SAN JOAQUIN LOCAL HEALTH DISTRICT 1 601 E.Haxelton Ave. 300 Wett Oak Street K � 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca, California f Trocy, California F.P.C 13. 1