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"r FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. 06__ G ------- -- ---- -- ------------------------ --------- (Complete in Duplicate) ________________________ This Permit Expires 1 Year From Date Issued Date Issued Application 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 compliance with County Ordinance No. 549. _ LCI 14 LqTH JOB ADDRESS AND OCATIONR(�� - _ `_77II.7 ." ..� 1 blNfT = - •-- ------- Owner's Name IJ- ��-MAL$------------------------------------------------------ _ Phone---------------------..------------ d Address y ---------� r� _ ��_ -----------�T��}------------ ---�=.----------------------'-- = i - 10 Cantrattor s NameU_4_4cf - - ----------•---- ---------------------- PVrie-------------------------------- Installation will serve: Residence E]�'Apartment House ❑ Commercial ❑ TrailerCourt ❑ Motel ❑ Other ❑ Number of living units: _ _____ Number of bedrooms -3___ Number .of baths _./__t,Lot size ...... ------------------r Water Supply: Public system ❑ Community system ❑ Private P",-Depth to Water-Table 0._c ___ft Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy,Loaam ❑] lay �olamm Clay ❑r'�Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yesj7rNo ❑ FHA/VA: Yes ❑ No [ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t - Septic Tank: Distance from nearest weU___115 --_-_Distance from foundation----to�'--------Material___C A/C �T`, No, of compartments-____ __ Size__y_x0_X_57___Liquid depth _ _____.Capacity----/ d rp Disposal Field: Distance from nearest well.__ -... Distance from foundation___©..........Distance to nearest lot line___) ii % Number of lines------------------------------------.--._Length of each line---._60_�_`�ra__..Width of trench----------'�-----.---_y_.------•--- Type of filter mafer�l:_R_P._cK.____Depth of filterlmaterlal..._...;j�________Total length------------ .5-0------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation----- -------------Distance to nearest lot Fine_______________._ ; ❑ Number of pits-----------------------Lining material-------------------- .Size: Diameter----------------------Depfh---_---------------------------- Cesspool: -------------------Cesspool: Distance fromfn arest well-----------------Distance from foundatio_n._..--t------------ Lining,material__________________--- -_-_--__-El 4 Size: Diameter- ------------- -..Depth--__---__------ ----41--- --------------------Li uid Capacity_. --------gals Privy: Distanc ef'from nearest well-______________--_______.________._.--._..___._Distance from nearest building.______.____________.__._________.._----_. ❑ --! : '.Distance�to nearest lot linei-rc----c=------------------------------------------------------- --------------------- Remodeling and/or repairing (describe)_-------_------------------------------- > --bCt`Sn P -------------------------------••--------- ------------------------------------ ------------------- P ------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------*-------------------- ----- I hereby rtify that I hav repared this application and that the work will be done in accordance with San Joaquin County C ordinances, to laws, and r rand ulations•of the San-Joe quin-Local Health District. (Signed (Owner and/or Contractor) - ---. ---- � --- .-- ? B - = (Title)- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .`_ -. '---------------------------- ---------------------------------------- DATE-------- -1_l-. '--------------- REVIEWEDBY-----------------------------------------------------------------------------------_--------------------------------------- DATE--------- ------------------------------------- --------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------ ---------- DATE------------------------------------------------------------- Alterations and/or recommendations:------------ ---------------- --------------------------•--------------------------------------------- -----•----•-------------------•----•-------------- -t t. -`1 137- ra �. FINAL INSPECTI -- - - ------ - R- - Date--------------- ---------------------- SAN /._ '-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California , I F.R CC. i� ti