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APPLICATION Fvo'�SANITATION PERMIT Permit No. (Complete in Duplicate) / S Date issued ____� Applica*ion 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. 544, JOB ADDRESS AND LOCATION------------ 46x9---Homaer--AV-°--------•---•-•-----------------------------•----------•-------------•------------------------ ------••---- Owner's Name-------IiAr'_IF __HOZCOmb Ho. 69372 --•----------------=----•------------------------------------------------------------------._ Phone------ - ------ Address------------------193001- 4-6Q9--Ho_aex---AY------------------------------------------I-------------------I--------------------- -------------------•------------------- Contractor's Name-------------------------------------------------------- Del ta------------------------- ----------------------------•-----------•--- Phone.__,..1.2-------------- 69 Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units-1------- Number of bedrooms ----Z_ Number of baths -1____ Lot size ----5PA 54--------------------------------------- Water Supply: Public system ElCommunity system ElPrivate ® Depth to Water Table ��___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe n Hardpan ❑ Previous Application Made: Yes ❑ Nod] New Construction: Yes 29 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 weN_________________Distance from foundation___________________Material_____----.--_-_----______._____________---______- e,vSStj_hg No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-----------•--------- Disposal Field: Distance from nearest well--.--------------Distance from foundation--------------------Distance to nearest lot line_________________ ea�]sting Number o; lines-_------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ �1 Seepage Pit: Distance to nearest well-----IDO---------Distance from foundation___ _Q----------- to nearest l2o }tri -------i__--__- ® Number of pits-1.-----------------Lining material-brick-----Size: Diamele ------------- --- ---Depth------- -----___ - -.--- Cesspool: Distance from nearest well-----------------Distance from foundation----_.------------- Lining material_____-.-.___---_-_-_------------ ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------_Liquid Capacity----------------------------gait. S Privy: Distance from nearest well-------------------------- ---------------------Distance from nearest building------------------------------------------ p ❑ Distance to nearest lot line--------------------------------- Remodeling and/or repairing {describe----------------- C C3 E1 __ -rr --33 t,---to jlgj� C!-:qc sus liCmT! ---------------------- .........................••--------••------------------------------------------------------------•-----------------------------.------------------------------------------------------------------------------------•------- ------------------------------------------------------------------------••----------------•-•------••----•••-----•-•-----------•----------------------------------------------------••--------------------------•----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County v ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. .4 (Signed) ---n 't�q--------------- ----------------------------------------------------- ----Owner and/or Contractor By:------------------------------P11-----------------------------------------------------------------------------------------------(Title)---• .b�g-r ---------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --- DATE----- --------------------------------------------- REVIEWED BY-------------•:--------------------- DATE------------------ - ------------------------------- BUILDING PERMIT ISSUED---_--------------------- --- ---- - _ DATE------------ -------------- Alterations and/or recommendations:-------- ---------- - ----------------------•-----------•--•----------------•-••-------------•---------- ---------------. -------- - ---------- -------•-----------------------------•...---------------------••-•--------------=------------ ------------- --------------------• - --•--••-----------------•------ ---1-- - ---- ---------- :, - -------- ---------------------------------------------------------------------------- . ------------------------------- g -_ --------- --------------------------------- u FINAL INSPECTION BY:.......... _�_ \) . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California "N. Lodi, California Manteca, California Tracy. California ES-4-2M Revised W-2100