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-- -------l.L VJ ' . ------ ----- -------------- --------------- APPLICATION FOW�:$ANITATION PERMIT Permit No. _. --------___--- (Complete in Duplicate) ------------ This Permit E ires 1 Year From Date Issued - - a Date Issued -.._-" __(D- - ThisApplication is is Re made o tha San Joaquin Local Health Di rict for a permit to onstruct and install the work herein described. This application Is i com ianc it{i Co O ' Y yS�i�nc No, 54 O J08 ADDRESS AND'" CAT] N.__.__� � =l-00!- .� - � Owner's Name___-__"-_ ri _ ._ -- / :�- E �Address. Phone-- - -- Contractor's Name__ ____.--- --•------------------------- -----•------•-•-------------------------•---- Phone----- Installation will serve: Residence ❑ Apartment House Commercial Number of living..units: - Number of bedrooms _ ❑ Trailer Court ❑ Motel ❑ Other [] O Number of baths _ Lofi size .��- is Water Supply: Public s stem - -�� -------- Pp y: �,,� Y ❑ Community system ❑ Private L�^i- Depth to Water Table 0,991t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ,�� Previous Application Made: {I f yes,date--------------------] No y ❑ Adobe 9f Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ��New Construction: YesNo El FHA/VA: YesNo ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well Zx -pis{once from foundation_... - ' �^ apacity No. of compartments_"-_ - ------.Materiai--4,ree, --:---Li uid depth ,,�� Disposal field: Number stance fr lines earest well._ �(rf_f_Distance from foundation `-_"--p t ce to nearest es}lot Length of each lin .1f" fine_" -""- ' - f 9 !?Width of trench_ Type of filter rrtaterial1 -De Depth of filter material-_ p ``- -_,-_Total fen th-_ Seepage Pit: Distance to nearest well- ---------------------------- - s' g �-- -------------------- �jii.`�-._-_Distance fr m foundation___--_ __ ( Number of pits--..__F - Z ------.Distance to nearest lot line_`"-.__.. ----Lining material-�-- --Size: {7rameter , Cesspool: Distance from nearest well--__-______-_ ❑ Size. Diameter.; - Distance from foundation------_-------------Lining material- ...`.----___.----_---- --------------- -- -----Depth ------- ---- _ -----• ---- -••---- ---------------------Liquid Capacity-- PnvY: Distance from .nearest well-- --gals. - Distance from nearest building ❑ Distance to nearest lot line-------------------------- -- g--------------------------------------- ----- --- -- ------ ----------------___--- ? -- ---------'--------------------------r----------- Remodeling and/or repairing (describe)______________' - `� ---------- ------------------I ----------- - --------- -----------------------------------------I --- ------------------------------------------------------------------------------- ---------------------------------- ------------------- ---------------- -------------------------------------I---------------------4- 1��4p I hereby certify that I have prepared this application and that the work will be done in accordance with San Joauin Count ordinances, State laws, and,rules�and!regulafio s of the San Joaquin Local Health District, q 1 (Signed)-- --- r By:. --•---------------------------- --------'----------- - r Contract r - �- e------(Tifle)---- o (Plot plan, showing size of lot, location of system in rela o wells, buildin s"etc., can be laced on reverse side). - - FOR DEPARTMENT USE ONLY r. APPLICATION ACCEPTED BY' ]i1 5 REVIEWED BY - _ ---------------------------------------- DATE----,L"- i-!-_ BUILDING PERMIT ISSUED: s*Y ----------------------------------- -•------------- --. = DATE = - Alterations an /or recommendefions:__ 1 F` DATE"--------------- 1y4�-aq� __ �o�______________ __?.�' -___- ,lkyr __ 1F `` v j�p� --S S-__ ____ _______________ -- - -------"------------------ ______________________ __________�-- ---------------- _. _.________.._____..._____.____... ___ __- _____------- __________________ _ __ _ FINAL INSPECTION BY:._..__-lam_.-,_ 4L436C ti ------------ =------ Date----7 r-(°-". (PS ----------------------------- SAN JOAQUIN LOCAL DISTRICT 1601 E.Maxelton Ave. 306 West Oak Street " 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street Manteca,Californio F.P.0 O. Tracy,California ��