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FUR OFFICE USE: -- -- --------------------- ----------- ~' 774 ,. APRLICATION"FOIt'SANI1'ATlON PERMlZ Permit No. , ----------- -------- ....--.._--.._._..._ -- (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 in compliance with County Ordinance No. 549. JOB ADDRESS AND LO�TlOt�SIP r�1E� _ � 1� �,��tt1---- F----.-.-f)FOwner's Name ... 4 RL ---=--- --------!`f/�� ----- "r-------------------- --------------- Phone_-.----------------------------•---- Address--------------RE--3 -P�C------12-7AQ_> . ------------------------------------------ Contractor's Name- _W1U -�-------------------- ----------------------------:---- --- - -- --------------------- ------ Phone------ -----------................. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ � Number of bedrooms 3__ Number f baths 2 Lot size Water Supply: Public system ❑ Community system C-] Private. Depth to Water Table ft Character of soil to a depth of.3-feet• Sand ❑ Gravel ❑ Sandy Loam❑Cla� Loamlay E] Adobe ❑ ;Fj� 0Previous Applicatio'-.Made.L�If_yes,date__..___.._..__ ) No -ew Construction: Y s No,❑ FHA/VA: Yes El TYPE-OF-INSTALLATION-AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic i9-0-1Distance from nearest well-.�- ' _.-.-Distance from fou dation___--_� ._.�___Matari I __C?111 G_ -ATE. - - r No. of com artments_ ._.-_� Size__ __ D X Liquid depth.-_ Capacity___1��. _�___ 0 pX� - - _ _ Disposal Field: Distance from nearest well...50-__:__._Distance from foundatibn_:___�.I :------Distance to nearest lot line�_i .______ Number of lines------- .r_-----------------Length of each line-- --____--t. Width of french---------2 _-_:---_---�---. Type of filter material---)30.C��-----Depth of filter material-.-, 1-1--_____._Total length___.__.____________1�p________- Seepage Pit: 'Distance to nearest well....l = `_.'_-__Distance from founds on�Q _ Distance to'nearest lot line__) 0 ❑ Number of pits— ____ Lining material____80 ..,Size: Diameter.''/_X...10_-----Dept h------/ ..--------------_ S Cesspool: Distance from nearest well ______.____.__Distance from foundation.__ --- --_------.Lining material--------------------------------------- E] Size: Diameter- ------------- -------------- -Depth------------------------- - ------------------Uquid Capacity----- --------------gals. "S Privy: Distance-from nearest well-----------------------------------__----------Distance from nearest building.._._____________--_-_________.____... ❑ Distance-to nearest lot line -- -------------------------- ----------------------- J y t Remodeling and/or repairing {describe):..................... � ------------------- {" = �__:_fT1Lc_G ----- ----------- ------------�"lg . ,,?� ------ -= - - ------------- ---- ---------- -- ------------------------------------------------------------------------------•------------------------------------ -------------------------------------------------------------------------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- ----- --- --------------- ------------- ------------------ --------------------- ------- �� Owner and/or Contractor Y. _ (Title) .. .._- -- --------- (Plot plan, shoving size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY' +- -��" ----------------------------------- -------------- DATE--------- REVIEWEDBY... -------------- ------------ ------------------------------------------------------ ----------------- DATE-------- --------------------------------------------------- BUILDING PERMIT ISSUED-------- -- - --------------------------------------- --------------------- -------- ------ --------- DANE. Alterations and/or recommendations:----------------- - - - ----------=---.---.............. /------------------------------•----- ---------- -------7=-" � arm -- 2 �7 - ---- - ---------------------------------- _, , T-------------------------------------- -- : ---------------------------- ------ --- ----- FINAL INSPEFQ DateQ-..L�"_� f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi California a, y� Manteca,California Tracy, California E.H.9 2M 1-67 Vanguard Press r