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FOR OFFICE USE: ms=s" Y Aea 1> ------------ Permit . APPLICATION FOR SANITATION PERMITo. - - (Complete in Duplicate) Date Issued ._. _.__- _ _ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct an nstall the work herein described,__ This application is made in compliance with County Ordinance No. 549. 3 $' D� IS�/gLfi°/� pp S! D ` 1 -------------------------------------------------- JOB ADDRESS AND LOCATION::.._ o[ _'-_ ------- - -- --OF _.... -------- `1 L71 �`�Cs� - '---------------=-=------------ - Phone. Owner's Name---------- L _- Address------------------- •------------- _ --�Rp[sem--------------•--/ift-�-c F�--'---"---------- ----- ------••-------------•-•---------. Contractors Name-----.__OWN---- -------•-----------------�•------- ------------- -------- ...� -- --•--- Phone--------------------------- ------- ; Installation will serve: Residence Apartment House Commercial [ITrailer Court' ElMotel [I Other ❑ rrDO 220------------------- Number of living units: ---[---- Number of bedrooms —. Number of baths -�. of size ___l-_...__--X_-__ _ Water Supply: Public system ❑ Community system ❑ Private.ga—U`epth to Water Table J ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [Clay Loam Clay [I Adobe ❑ Hardpan [ � Previous Application Made: (If yes,date----_--------------) No E�' New Construction: YesB—No ❑ FNA/VA: Yes Ej - No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -(No septic tank or cesspool permit}ed'i{public sewer is aveilahle withili 200-feet")-J Septic Tank: Distance from nearest wek___?Z�_.--Distant from foundation---/ ---------Materal _C'aN �.- I;F--TT=------ - id depth------ ZCapacity---- zQ7 ,E No. of compartmLLiau ------- ze- 5 Disposal Field: Distance from nearestwell---�.D-__.-.Distance from foundation-___ --____Distance to nearest lot line---- Number of lines___.-____,:/- ---------------------Length of each line----- :-r{---Width of trench.---------2 - -------f-- o� Type of filter material___ f?_ - Depth of filter material-- __1.7'_---____Total length--------------------------174 -------- Seepage t nearest lot line____ '`- 000 Seepage,Pit: Distance to nearest well___".�00_.___-Distance from foundation____ L� ----- . Number of pits-.----Z-__----Lining maferiai_P��r�....Size: Diameter__�f___%�.---,-_ -----.Depth--------/---------- Cesspool: Distance from nearest well-----------------Distance from foundation___________________ Lining material------------------------ -_____-_. ❑ _� Size: Diameter _.-_� ��_----- Depth_- �- �.;.--� id Capacity �. �,.gals, Priv Distance. from nearest well----------------------------------- Distance -------- --- - _ . Disfiance from nearest building. y; ❑ ---------------------------------------------- 7 Distance to nearest lot ine______-----------------------------------�-.-- ------------------------------------------- IL• L . r Remodeling and/or repairing (describe):------------.......• - -------------------------- ---•------•-------------------------------------- I ` --------------------------------------- ---------•--------------------------------------------------•------------------------....... ----------------------------- ------------------------------------:------------------------------------------------_--------------------------------------------------------------------------------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc tate laws, and rule and regu ions.of the San Joaquin Local Health District. (Signed)--------- --------------- ,- - - ---------------- --- -------- -------------- ------------ ---------- -----------------------(Owner and/or Contractor) .r-_ - -- - �., �r.. gy._..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 BYL.FZ' - --------- ------- -- -- ------------ ---------------------- DATE------ ^Z~. .��~ REVIEWED BY---------------------- --- DATE -u ------ BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------ DATE------------------------------------------------------------ i. Alterations and/or recommendations:--------------- -------- ---------------------- --------------------•---------- -------------- -- r ---- --------- ------------------------------------------- -------------------------- ... ------------------------------------ --- ---=---r ----- -- - :__: -- _::_: -::__:::__::_: .... ---- T ---- - - __ - 1 - - Y� FINAL INSPECTAQV_.BY_� � -- - / L` ..../f ------------- Date. r 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 tGsaw�si3� .