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Drk-.oR vrnt-t u5t: -------------- APPLICATION FOR SANITATION PERMIT Permit No. ...Z_7_?-j-.. --------- --------- ---------------------------- (Complete in Duplicate) -------------------- ---------- --------------- -- --- This Permit Ex ires 1 Year From Date Issued Date Issued _ �r(QC 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. ��i wA-�y JOB ADDRESS AND LOCATIr N_ Owner's Name-------L-°E-C-�---- :-�-�'��C� �`%v •�.�-------- ,:_.. - - - - - Phone----------=-- � Address-------- f Contractor's Name t " --------------------------------- Phone------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ f-- '/ f Number of livingunits:_-- Number of bedrooms .:__- Number"of•=baths__�___Lof size_`4W/ Water Supply: Public system ❑ " Community system ❑ Private ie`th to Water Table. ft. Imo'! p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [] Previous Application Made: [If yes,date____________________J No r [ New Construction: Yes V4 No ❑ FHA/VA. Yes ❑ No ®--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is a'vailal3le within 200 feet.) 1 f�. Septic Tank: Distance from nearest well__f __Distance. froth:foundation.- , �,�'/ �� „r _ ,r Material �-, --1 - --------------- No.`of corrin art ents__-- -- -- Size ,_,.ZJ�_SII Liquid depth-----f� ------------CapacityC—f+ ----- Disposal Field: Distance from nearest weli..�__PZI- Distance from foundafion_�w_� -- p Distance to nearest lot line_ ___.__, Number of lines.___ _ _____ Len th of each fine____ _ _ �_ a. 9 �1_ ______________Width of trench. Type of filter material_ 1,-l. fi' ------------------------------ I /_Depth of filter 'matenaL__ ._ ___ Total length ��----------- Seepage Pi Disfance to nearest weif / ( ----Distance frgm famndation____ .f_.Distanc,e to nearest lot line_, r Number of pits-__f_f__..___.___Lining material__�t94_ -_---Size: Diameter___� .--__----_-Depth_ �``'/Yl �Yrt_ ,u, 1 Cesspool: Distance from nearest well__�-----------Distance from foundation..__.___ _____linin material______ ______ ____ _ _ Lining ❑ -Size: Diameter---- --------------r-------------- Depth------------- -------Liquid Capacity ------------------ 9a--- l Privy Distance from nearest wall___..______-----. . f ___________________Distance from nearest buildin 4 ❑ Distance to nearest lot line---- -_- g. ----------------------------- - -_ a _ _ Remodeling and/or repairing'(dascr'be),:---- � ---------- -------- /� f� ' �� -- -------- f � ! `�' f f- ---- -.1 - --- a i ✓ G -------------------------•---•- ---------------------- ------- --------- 'f7 ------------------------------------------ -- -- - -- --------------------------- --------------- - 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)__ 7 �J ----- - -----'-- ------- - ---------------------------------(Owner and/or Contractor) 7 8Y --------- l ----------(Title)- .c1% i----' -- - , -- (Plot plan, showing size ofllot, location of system in rela#i n fo wells, buildings, etc., can be placed on reverse side). { —x t �,:�"--FOR-DEPARTMENT (ISE-ONLY) �..._.. -..._.. . APPLICATION ACCEPTED BY---_ _- - ----` '{ ----------------- DATE------Q---Z9-'- - --- REVfEWED BY ---------- -- ------ ----------- ---- -�- - -- X0-- DATE--------�-------- --- ------- ILDING PERMIT ISSUED- ------- S ----- - ATE --- --------- Alterations and/or recommendations:__..4'_ _ (� -- _ ] 1-h� h___._------_- A. -- _._ .- o -,-�/------------Q--t--�--- `-----f- =�---- - --+6------- �. i ---------------------------------------- ------------------------ ` ------------------------- ---------•---'-_-'--'-............................ ------------ w ------•----------------------•----------- FINAL INSPECTION B.,Y:..t_C__-,--- ----------- Date---- .10_'- -- ----------------------------- �r� SAN JOAQUIN LOCAL HEALTH DISTRICT 160 I-EM411on Ave p 300 West Oak Street _ 124 Sycamore Street `� 205 West 9th Street Stockton,California`—-- Lodi,Calif r ' - x t Manteca,California. Tracy,California