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FOR OFFICE USE:= --- APPLICATION FOR,SANITATION. PERMIT APPLICATION No. - (Comple a to uplicate) Date Issued,/Z-7,7-7 --- ------------------------ --- ----------------- ------ 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 descried This application is mad-e--in,.compliance with County Ordinance No. 549. -2-07- 7-'?0 � Q .SGAL � fl- JOB ADDRESS AND L CATION. ` d 5��1�- --Sj-. -_11�4GCL �IO-@� '"'rr -iP ,�Ray✓s2F ............................ .............IA------- -- -1�A 1�` Owner's'Name--=.-------�A� -f___�_�--•----------- l�DAhone- -- --�p---- �'w Address-----FAME-------------•----------------------------------------------------------•-------•---------------------•--------------------:----------------------------------- ---:--------------- 1 Phone-------------------' :� ----- --------- Contractor's Name------ .r ---- ll�_7X�1 C.T, -.•------------ - - - - - Installation will serve: Residence% Apartment House El Commercial E] Trailer Court [:] Motel ❑ Other [I' Number of living units: __1___ Number of bedrooms,__-{NumIj ber of baths __ --- Lot size --7-Y. ��-------------------------- Water Supply: Public system ❑ Community system El ='P_riya,'� Depth to Water Table - Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe E] Hardpanx Previous Application Made: (If yes,date_.._-_'---'_�A No% New Construction: Yes [INo� FHA/VA: Yes ❑ No�. TYPE OF INSTALLATION AND SPECIFICATIONS: - --, -(No-septic-tank-or-cesspool-perrriitf�d if`public-sewer is available wi+hin 200 feet-}-_ I Septic Tank: Distance from nearest well------ ----------Distance from foundation___________________Material.._____-- - �"(SIIK� No. of compartments-- ------I- --.'__Size-----••-------------------- ---Liquid depth------------------------..Capacity-------------- -�--- Disposal Field: Distance from nearest well___SQ------Distance from foundatio _'__ ------Distance to nearest lot line__ .-_..__ ,. %-rld& Number of lines------------_./------- __._______Length of each line_____________--------A/------Width of trench.._ .__!_ Depth of filter material___./_..___.--- length/s------------- T ype of filter material--_- c.: __:Seepage Pit: Distance to nearest well--- m foundation-c=._______ (___.Distance to nearest lot line.._________._ Number of pits.--.- ----:---_----..Lining material- _QGI�_-.-::Size D*amefer- -----____--_--Depth -- -`t--------- - ... Ln Cesspool: Distance from Meares}.:we{I.- _}- __.:_Z bistance from foundation................... Lining material__..-_--_____..______-.______.___.-. -� ; _ f F _Li Liquid Capacify-. gals. I ❑ Size: Diameter.-------------------------- ------- -Depth--------------------- -------------------- q P Y - ;. Privy: Distance from nearest well-______,__------------------------------- -....Distance from nearest building------------------------------------- - r - --------------------- - T ..-. ❑ .Distance to nearest lot Zine ------------------------------ --------------- - / 4 dr <cl�T/a/v!._- 1- - r�f�T ---f ------------------------------- Remodeling and/or repairing (describe):__ ._,_____. . ---------------- ---=----•---------------------------------------- ----------------------------- -------------------------- ----------- ------------------------------------------------------------------------- ---------------------------------------- --------- ---------------------------------------•--------------------------- ------------------------------------------------------------------------------------•------------------------------•----------------- I hereby certify that I have prepared this-applica+ion and that the work will be done in accordance with San Joaquin County ordinances, Stale laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -------------------------------------------------- --------(Owner and/or Contractor( - --- - ---------------------- (Plot plan;showing size of lot;location-of system in-relation to wells, buildings, e+c., can be.placed on reverse side). s FOR DEPARTMENT USE NLY - F APPLICATION ACCEPTED BY ! 0 ------------ DATE---- 7._.-�a ----------- --- ----------- REVIEWEDBY--------------------- ---------------------- ----------------------------- --------------------------------------------- DATE------------- ------•-------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------- ------------------------------------------------- DATE------------------------------ ------------------------------ F Alterations and/or recommendations-------------------------------- --------------------------------------------------------------..------------ - ---------------••-------------------------------------------- ------------------------------------------------------------------------ v-------------------------------------------------------------------------------------------------------------------- ---•------ -- ----- - ----� -------------------------------- --------------- '-------------- —---- ------------- -- --- - -- - J4/4- -&/ -FINAL INSPEC�'td—BY:. _.... .-1 e --- ----- ---- Date------- ' . k SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ttazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co. r