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FUR UrrIL:L USt: rr> APPLICATION FCR-SANITATION PEWIT _ Permit No.--------------------------------------------------------- .1� .. ---------------------------------------- ------------ -- (Complete in Duplicate) Date Issued h�n_,7-20�� .......................... This Permit Expires 1 Year From 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 complian�ccp with County Ordinance No. 549. ETSC W ` / h JOB ADDRESS AND LOCATI �--jN ------f 019_x--_}}_?42$ -----PD------------------------F-----Q� B_RE ev-A-t1 -------�V Owner's Name-------------------< 1 B_L 5--------------�7-iA R_� �`�---------- . ------------------- ---------------- Phone------------------------------------ Address------------------------R.rF.----.:I... --------------pp?(------------- 66.0--- /V---------------------•--------------------------------------- Contractor's Name------1, W_ ...N-E{�--•--•--------------------------------------- - ------------- -- ------------------------------------ ------ Phone..--------------------------------- Installation will serve: Residence ©- Apartment House ❑ Commercial ❑ Trailer Court [:] Motel [-] Other E]_ Number of living units: -4--- Number of bedrooms -'3-- f- ,-- Number of baths ------ Lot size .__ } ..... ---•---•---------- Water Supply: Public system E] Community system El Private�epth to Water Table 35-ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam �ay E] Adobe E] Hardpan Previous Application Made: (If yes,date-_.........--------I No F*" New.Construction: Yes J?-NoE] FHA/VA: Yes F� No ❑ -.TYPE OF-INSTALLATION-AND SPECIFICATIONS: = - - - - - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep#ic T Distance from nearest well____SD____Distance from foundation------I_�----_-Motor- I---Ci _ — No. of compartments.-,...- -----------Size-_4V_V4?.k_57__Liquid depth---- Z..-.-Capacity_..-_/4p-52-- Disposal Field: Distance from nearest _._Distance from foundation----LQ__----.-.Distance to nearest lot,lin [� Number of lines----------------I--------_---_---Length of each line--------�?Q----rill Width of trench-_--2_y-_!- Type of filter material----j?QCK...Depth of filter material------1---__.-_--Totaf length------------------9_0--_---_-------- Seepagert: Distance to nearest well__/_Q_ -------Distance from foundation-----/40--------Distance to nearest lot line--.5 ----- Number ofp•its...._�j-___-�__ ___. f --_Lining material__ -��iK...Size: Diameter._-�,�j___.-___Depth_______1F.�__ ______________ Cesspool: Distance from nearest well-------------._-_Distance from foundation---------------_-.Lining material------ ------------- ----------- ❑ Size: Diameter-------------------------- ----Depth---------------------------------- - - -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building.--..----.__---._--.----___---.-.--_---- ❑ Distance to nearest lot line-- -- ------------------------------- ----------------------------------------------------------------------- Remodelingand/or repairing (describe):------ -----------------------------------------------------------------------------------------•-•--------•--------------------------------------------- ---------------------- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- -------- ------------------------- ----------------------------------------------------- ---•--------------------------•-----------------••---•---- ------------------------------------------- -----------------------------------------------------� -------------------------------------------------------------------------------------------------------•------------------------------------•------------------------------------------ - ------------ - - -- --- - -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, arlc rules and regulations of the San Joaquin Local Health District. (�1,1 � � (Signed -------------------------------------------- ---------------------------- ------------------(Owner and/or Contractor} By:------------ -----------------------(Title)--------------------------------------------- ......... r--- (Plot plan, showing size of lot, location of system in relation tow s, buildings, etc., can be placed on reverse side). FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY--------- -------------------------------------------------------------------- DATE------- ----------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE---------------- ---------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------._ DATE------------------------------------------------------------ Alterations and/or recommendations------- --- -- ------ ------------ -------•---------------- P! 7 .------_r`�r _----- X04- .. _.. . ------------------------------------ ----------------. ---------- ------- --------------------------------------------------------------------------------------------------------------------------------...... - --- --- - - ----------------------------------------------------------------------------- ------- -------------------------------------------------------------------- FINAL INSPEC ON BY:-__ .�__ ------- --------- Date-------------------�- -.~_ .__' r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Avr. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stotkton,California Lodi,California —x Manteca,California Tracy,California