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FOR OFFICE USE: S---------------- --- ---_ APPLICATION FOR SANITAi>iON PERMIT Permit No. - -------------------------- - --- --------------------- (Complete in Duplicate) �S 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 cdnstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__Cont_ Vista--Dr-._------Lot---#3-_ZInden=-------------------------------------------------------------------- Owner's Name__NQMe_ ! _-Construction-- °------------------------------- -------------------------- -------------- Phone------------------------------------ ! Address------9-3.9-'--X33^en9_0---}-d-. 3 to=r,kt0n----------------------------------------------------------------------------------------------------------------------------•------- Contractor's Name'= 1Yc]mellini-_G_ons-true i_on--------------------------------------------- 20 ------ Phone__ Installation will serve: Residence El Apartment House ❑� Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ __ Number of bedrooms --3_ Number of baths ---1-- Lot size ------` 5X147------------------------- Water Supply: Public system ❑ Community system a. Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam g Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------ -----------) No New Construction: Yes ® No ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------5-0-f-t Distance from foundation_Q':Ft-+_-_..Materiak___R-edwO.ad______________________- No. of compartments-----------2-------:----Size---4x995--------------Liquid depth-----4ft-----------Capacity-_a.2.4Qgal. Disposal Field: Distance from nearest well-.-5-0_f tpt Distance from foundation.l�!.---Distance to nearest lot line-5-T--t-,---- 12 ine_5 f -,___- ® Number of lines---------------2------------------Length of each line------ ------:Width of french-24i-n.,------------------- Type of filter material-ROok_----------Depth of filter material-_7-9` n-_...__Total length------ Seepage Pit: Distance to nearest well_..QQft..---Distance from foundation____ Qf _.. Distance to nearest lot line__5"lft.__._ FA Number of pits-------2- --- Lining materialBQGk_-___ _ Size: Diameter-__. 31.1:____.Depth------ 5 fl.-- ________. Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material_-_-____________-_-------_______-____. ❑ Size: Diameter----- ---------- ----------Qepth---------------------------- - --------------------Liquid Capacity----------------------------gals, ' Privy: DJ stance from nearest well-------------------------------------------------Distance from nearest building-----------__-_________---__-______- ❑ Distance to nearest lot line--------------------------------------------- ------------------------------------------------------------------------------------------------ �. Remodeling anor ,repairing Idescribe):---------_ - � ` � p !' --c-F h---------------------------------------- -------------- -------------------------------------------------- i ----------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------- I here6y 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. �r (Signed)----------------------------------- - --------------------------------- - - -- ---------------------------------- --- -------------------------:--- ---(Owner and/or Contractor, By:-------•-----Y � - {Title) ` (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 �j� �4�---------------------- DATE---------/" - -- - ------------ REVIEWEDBY---------------------------------------------------------------------- ------- ---------------- -------------- ----- DATE---------------- ----------------------------------- BUILDINGPERMIT ISSUED-------------------------------- ----------------------------------------- ------------------------ DATE----- -----------------------�---------------- Alterations 4nd�-Qr—recommendations:- 4� ~' ��' f---- ---- .9--,. % ) � 'r `�� C ------ --------------- ---------------------------------------------------------------- ----- - --- --------------------------------------------------------------- --------------------------------------------------------------------------- /Y FINAL INSPECTION BY:.- rN!JOAQ /l Date------- . UIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.c n. r �