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FOR OFFICE USE: --_-_-----_---_--__-_-_---___---------_ ------------- µ; APPLICATION .EOR 'SANITATION PERMIT {' Permit No. --cAQ--� - (Complete in Duplicate) l ----------------------------------------- ------ This Permit Expires 1 Year From Date Issued f Date issued Application is hereby Tacle to the San Joaquin Local Health District for a permit to construct and install the work herein desciLbgd This_application-is a in co p' rice with County Ordinance No. 549. E h'1 f Cn il 11 JOB ADDRESS D LO ON--------- Q'. f l+(`rCA------RD-----X�_r---- 5-40-J-1-----V^-IF-O-P!I�l/lr�A.J' D--- anl------•--8*q F__T!; � r I Owner's Name -= Phone--------------------•---•-----__---- F Address ---P-__O------8-O-x - a_^-3-----------MANE<A-_•-------------=-----------••-• ' = : = - 1 t Contractor's Name_-1,I _ ` - +�5------� 1�.__�_�-�J�-��-------------------- ------------------------�-------------�-.Phone----------�------�--�---------� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer iyewt`®"T ote ❑ Other ❑ r �i Number of living units: �.--_- Number of bedrooms 2—Number of baths �____. Lot size ___ ___._-.�-� �___ Water Supply: Public system ❑ Community system ❑ Private J�r'Depth to",Water Table?V ft Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Cla 'Adobe ' 'HaYrd an I p ❑ Y ❑ Y ma El Y ❑ ❑ p ❑ pp { y 1 --------------------- ) 'No New Construction: Yes ��❑ LA/VA:'Yes ❑ No 0' Previous Application Made: if es,date _ TYPE OF INSTALLATION AND SPECIFICATIONS: 4- + I (No septics tank or:c2ssspo�ol permitted if public sewer.is avallahle within 200 feet.} Septic T nk: Distance from nearest well d D'stanc from foundatian,AQ -Mater! i 6Q�_C�_ rk -__-_---. �� No. of compart encs----- ------------ - _ _-- -- X—5 --Liq,ti, epth-- -� ---Capacity.... �-- _Size__ ��_, Disposal Field: Distance from nearest well..- C�- Distance fro foundation__-IV_--Distance to nearest lot line..... Number of lines____ ___ �._ - Len th of each line•_____ _ ) 9 I�,C1-- !: Width of trench. . ----- -Y Type of filter material__ G_C-K"Depth of filter material_- Total length-----------------------Inn-------- " I i Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-.__----__-__--_- ❑ Number of pits-1...................Lining material-----------------------Size: Diameter--------------:--------Depth--------------------------------- Cesspool: Distance from nearest well________________Distance from foundation...'------------ maferia --------- 0 Size: Diameter I --------------- --------------De th--------------------------------------- ❑ I p Liquid Capacity gals. Privy: Distance from nearest well_________________'�_____--______.____..-------.Distance from nearest building----------._____----------__----_--_----_. 3 ❑ Distance to nearest lot line------------I/------- ------------------------------------ -------------- ------------------------------------ -- - -- -r------- Remodeling and/or repairing (describe) -------------------------------------------------------------------------------- ---------------------•---------------------------------- :. I f1 -------------------------------------------------------------- ---------------•------------------------------------------------------------------------------------------------------------------------ ------------------- i ----------------------------------------------------------- ------ -------(------------ - \ i ______________________________________________________ _ ____________________--______________________________________________-________ __--_---_________-_-_--____-__----__-.-_-____--_---_-_-------_-_ I hereby certify that I.have prepared this application anc!'that the work will be done in accordance with San Joaquin County ordinances to laws, laf ns_ ....the San Joaquin Local Health District, (Signed -------------------- (Owner and/or Contractors t► -- (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 F, APPLICATION ACCEPTED BY----- _- -C�-'---------------------------------- --- DATE--------/�'?6_" _6---•-- -------------------------------- - --------------- REVIEWEDBY------------------------------------- ------------------------------------------------------------------------------------ DATE------------------------------------------------------------- BUILDING'PERMIT ISSUED--------------- -------------------- ----------------------------------------------------------------- DATE--------'--:----- ------ 0 Alterations and/or recommendations!__------__-- "a I ------------------ ---------------- 11�0T - G?FA�IGtr .-.-1(yl14�lJCJ'T�` QN-----13�E1 .A--------------------------- ----------------- ------------•---------------------------------------- ------------------------------------------------------------------- - -------------------------- ------------------------------------------------------ iy ...................._--------------____-----------__ __-_ - ---------- ..__._ __ .-.`_ __ ._-_.--------------------------------------------.-----------------.----------------__-__-___--____-_-_____--------_ FINAL INS BY: -2; ------ ----- � --- ------- Date-------------------- -- �- - - - -- ------ # SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co. 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