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r rt vrr l.t L16t: /o ------------ � ----- .5A,_ ---- 0 APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) d _ ;This Permit Expires 1 Year From Date Issued Date Issued -i.__�_.-y/6� ' Application is hereby made to the SanJoaquin Local Heal+h District for a permit to construct and install theework herein described. This application; is made in compliance with County Ordinance N 549. JOB ADDRESS AND LOCATION__�I i Z . _ .__- T i Owner's Name-------------Jo's�� 1 �1. Address ----------•---- �' x 1'r ��._ Tc . -- - - ------------------ Contractor's Name------ ------------/Q�.�-IS/1 /r�Y, R 1 l •---- ------------------------- ----------------------------•--- Phone Installation will serve: Residence ®'partmenf House ❑ ,Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: __..f Number of bedrooms -3_I—Number of baths - 1Lot size ._SS_ C�X�44 r s" - .-_ --------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 4 ft. t ' Character of soil:to a depth of 3 feet: �Sand ❑ Gravel ❑ '-Sand Loam Sandy ❑- Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,do e--------------------) No Ejj New Construction: Yes ❑ No ®— FHA/VA: Yes ❑ No E�- TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank or cesspool permitted, if public sewer is available within 200�feet.] r I ._ . ._.. _.._ .._.. _.. - Septic Tank: Distance from nearest well----------------- from foundation-------------------Material--------- Fl. No. of compartments size. = ---Liquid depth--------- --------------Oapacify------ ........ Disposajeld: Distance from nearest wdil, " _'Distance from foundation-/D__/_-__.._.Distance to nearest lot line-- - Number of lines__._t -------- --- Length of each line__/_V_ -----------_Width of trench-_-.e f�'--------------- �} Yi 7 Type of filter material--S </�' {: _Depth of filter material---� '------------ -- Total length_�_/.�+��J------------------ a - � rt s ----- N cepa it: Distance to nearest wall-.lQ.-- _'Distance fr m foundation____ ________ �� - Distance to nearest lot line-�_-----, Number of pits----- .--f__--------Lining material_S,!_k1*t------Size: Diamefer_ -` ---------Depth-- --------------------- Cesspool: -.-------------- -_�. Cess ool: Distance from nearest w+ell___--_._.----€-Disotance from foundation _..-__----.----1-.Ligning material ------------------ -------- 1 ❑P P Y - ---- --gals. Size: Diameter------ Depth )-Liquid uid Ca aclt i ------ --- -- Privy: Distance from nearest vie1f ------------------ Distance from nearest❑ building -----. Distance to nearest lot linhe _ OF (, ; = , ------------------------- Remodeling and/or repairing (describe1 c - ----------------------------------------------------------- ------------------------------------------------------------- ---------------------- i --------- ----------------------------•--------------------- - -- -------- -------------------- ---------- hereb certify that I have br _ _ __ - - - Y Y prepared this application and that the work will be done in accorda5ce with San Joaquin County ordinances, State laws les and regulations of the San Joaquin Local Health District. -(Signed)-•------- --- -------- 2; - �/�f -:---- - ----------------------------------- ---------- w rand/or Contractor) , By --- -- --- ---------------------------------- -------------- #__4Title p 9 of Ian, showing size of lof, locati n:of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.--.._.____ # - --- __----.'----- ..------ --:---;------ ------- DATE-------1? s.4 REVIEWED BY---------------------------------------- - ------ --------------- -------------------------- -- ------ --�----� DATE------ BUILDING PERMIT ISSUED------------- ----- I ----------------•------------------- -- ------------------- D E------------- Alterations and/or recommendations:.-.___ ------------------------ -------------- --------------------------- ------- -----------------------------------------1"_--------------A=--------------------------------------------------------------------------------- ------- --------------------•---- FINAL INSPECTION BY:._ '-------------- - ------------ Date-- -------- L:45�X_5 .� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ` 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co.