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FOR OFFICE USE: - ------ ----------- ----- APPLICATION 1=4R SANITATION PERMITPermit No. .. .... ------------ -------- -------------- ---------- ---------------------- ---------- (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 and install the work herein described. This application is made.,in compliance with County Ordinance.Nfo.,549. 2�S- l3D•-lJ A�-o� w _ Al i r +. JOB ADDRESS-AND LOCATION._..--_....I'.! LL�------- Z�. -- -------W Owner's Name----------------------��r) -----•---- _c,,..•..- ,:-------------- - - -------------------- --- Phone------------------------------------ ------- Address----------- TF - 1--•----•---13 x--------9110---------"--#.--f t--- L..Q--- Contractor's Name__AVCA---- 11.1 ,� \i.�_ .---------------------- ----------------------------------------- Phone-------------- ---------------•---- Installation will serve: Residence ®Apart ent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I-.._ Number of bedrooms .Number of baths Lot size .___.._1-rG - A -� -.-�,..,,,--I Water Supply: Public system ❑ Community syst �m ❑ Private ❑ Depth to Water>Tab1;e 181 ! .. ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam_[.] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--_-...__._{'"'"- ] N6'P— New Construction: Yes ❑ No �HA/VA: Yes ❑ No E]( Z4 � �5 TYPE,OF-INSTALLATION.AND�SPEGIFICATION-s., - +;e = » (No septic'fank or cesspool permitted if public sewer is available within 200 feet.) _ J Se tic Tank: `T{"Distance from nearest well -- r; r s :_-.•Distance from foundation-..__ .Q.----....Mat ri I_�0-----e--- -�� f�0�i No. of compartments....__- Size__ _ -Liquid depth'_..-_a� �-----Capacity.. ��. - r X p _t Axl* "�line-.---/ ! Width of trench--------�1*.r► Dis osal Field: Distance from nearest well-__E.�J�...:Dist nce m oundation---------------.....Distance to nearest lot line_-._...._--_.-._ n ®� Number of Imes____________ _ PLength of each Total length-----.___--..._.-_..__ - Type of filter material--__ O C_ 1 _Depth of filter material..._J.7. ,t _ Distance to nearest lot line_____________ i Seepage Pit: Distance to nearest well..............._�_--Distance from foundation ❑ Number of pits----------- ----------Lining material---------- --------Size: Diameter-' ---Depth--------- ----------- ---------- J Cesspool: Distance from nearest well.._.}.--------Distance from foundation----------------- --Lining material---..._..- - ------_Depth------------------------------- ----------- --------- - Privy: Distance from nearestliquid Capacity--- ------- --------------- ❑ Size: Diameter----.----.-------------- m ----.-Distance from nearest building ,welk Distance to nearest'lot line -- ------ ----- ---- ------------------- ---------- ----------------- --4---=---- ------------------------------- ------------------------ - - - - Remodeling and/or repairing.(describe) HE.pja -E------l_x1.GT11q�r------- -• ---------------------- --------•--------------------•-------------------- ------ -- ---------------- ---------------------------------------- -------------------------------------- t ---- f I hereby certify that I have prepared this application and that the work will be done in!accordance with San Joaquin County ordinances, St aws, d rules and regulations of the San Joaquin Local Health District d (Signed) - -----_------_ r - �� ---- /1 E _ _ (Owner and/or Contractor) T J ,�. --------------- --------------------- - ----- -------- By:_ ------------------------------------------------ -------------------------------------------- - ---., (Title) (Plot plan, showing size of lotjocation of system in relation to wells, buildings, etc., can be iplaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ 1 ' Os------------------------------------------------ ATE----- �l I k� 4 ��_- ----- REVIEWEDBY---- --------------------- ------ ------ --------------------- ----------- --------------- --------- -------------------- DATE-------------------------------I -------------------------- BUILDINGPERMIT ISSUED----------------- -------------------------------------------------------------------------- ----- DATE---------------------------------------------------------- -- Alterations and/or recommendations ---------------- - ----- -----------------------•------•----•----------------------•------------------------ r ------------- 1 FINAL INSPECTI BY:-. '� Date y "� 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 F.P.CO.