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rQKUl-H ,.t USE: ----------- ------------------------------------------- APPLICATION FOR`5ANITATION PERMIT Permit No. 19Q1_61a ------- ----- ----- --------- --------------------------- (Complete in Duplicate) ' --- - ---------------- ------- ---- ------ This Permit Expire 1 Year From Date Issued Date Issued - _-ZZ - - fires Application is herebymade to the San Joaquin Local H District for a permit to construct and install the work herein described. This application;is made In compliance with County Ordinance No. 549. LO�07 JOB ADDRESS AND LOCATION_-t_--�_-_CRM _ 19 --- Owner's Name-------------47,�TPW SRT"-- - -- - - ------------- -- - - ----- -..._.Phone----------------------- Address------------------ ��--`..-_�-`----6©x--------- l -I- � t-------------------------------------------------------------- Contractor's Name-----.-�W'(�OF-K-_-------------- Installation will serve: :Residence __ Number of bedrooms Number of baths _-" Lot size --- ._-_ Water. Supply: Public system ❑ Community system,[:] Private 2-16epth to=Water Table - - ft. Character of soil to a depth of 3 feet: Sand �/G�avel Sano! Loam Clay Loam Clay c`' � r ❑,�,/-y ❑ Y ❑ y ❑ Adobe ❑ Hardpan ❑ � Previous Application Made: (If yes, ate=__•---_------..__...I No /L7 New Construction: Yes �9�o ❑ FHA/VA: Yes ❑ No TYPE OF.INSTALLATION AND SPECIFICATIONS: ,�•-.�l _�-�- -., y.� rte'_ - (No septic-fank o,7cesspool permitted if puFi[ic sewer-is'av`aai1a151e—within-200_feet.)T" Septic Pink: DistaIf nce from nearest well---- ____Distance Distance from foundation....Z Mater I CdE-7 No. of compartments----�_;-----__-_-_Size-��(/D�( 'Liquid depth-__�/ ------_Capacity--.,1_.31J�- Disposal Field: Distance from nearest well--'_s 'Ca.-Distance-from,foundation---_/ -_ Distance to nearest lot line...`) •- 3 [}� NutmL7er of lines---------�--_ -- Length of each line--`„ .� t -.Width of trench---------3j*;--_ T e of filter material-_- >OCY�_ De th of filter material-_ -_ __ �� Yp p ------Total length----------- I , Seepage Pit: Distance to nearest well--------------------Distance from foundation_------------.------Disfance to nearest lot line--3---- ❑ Number of pits--------- material-----------------------Size fiameter--.----------- Depth ----------- ----- Cesspool: Distance from nearest-well--_.-_:_----~_.- Distance from foundation-_-_-----____- j:t Lining material ❑ Size: Diameter ; ---------------- ----------------Depth---------------- -- ----- -- --_-------Liquid -Capacity---------------- -------gals. Privy:- Distance from nearest we4.-__?------------------- +Distance from nearest. ❑ Distance to nearest lot-ling/ ' * # g �J dr' �t_ z ---------------- ------------ ` - ------------------------------ Remodeling and��rfepaFring (describe :-----//0._-- _--_v�6_ ---.:- l� Ot rcH------_Q. D tlN 1��/}-,1� pg DIS -------------------Q--•--1 - ` � bs-` ----xial cr-----NOT----XFORf"FED 6F-------2Y 4 LIM►rT"-' 1Q�-p R Pf CXR 'i Ri C JI-Iii- l-fEl � a�- a 6-" 's ' 30 '----- =-�R----- �pRQOAO----`-----VA.A_u41VC._.----b K "t'i - --C ---------------------------- : I hereby certify that I have prepared this application and that the work will be done in accordance-with San Joaquin Count-I"' ordinances, State laws, and rules and regulations-of the San Joaquin Local Health District. (Signed)--------- --- ----- - - I -- ------------------------------------ --- -------------`--:----------------------.(Owner and/or Contractor) y .an, - t --=-------=---------------------------(Tifle) _ - -� (Plot plan, showing size of lot, location sfem in relation to wells, buildings, etc., can be placed on reverse side). �a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,_,._777T7R_-0 ---- ---------- - --- --------- ------------- ----------- - DATE- --- - --�----`- REV)EWED BY --------------------------- - - - -----._ DATE------ - -- ------------------------------------ - -- BUILDING PERMIT ISSUED---------------------------------------------------------------------- ------------_-------------------------------------- DATE Alterations and/or recommendations:----- -L ecommendations:_-"-- .............. - -- ---- - -------------------- ----------- --- - -- ---------------------------- FINAL INSPECTIO -- ---- Date- ---� -�6- ...... -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California lt Lodi, California Manteca,California Tracy,California F.P.CO. r -