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r FOR OFF-I:LSE; APPLICATION FCSANITATION PERMIT Permit No. -- R" -------------- ----- ----- --- ---- --- ---------- (Complete in Duplicate) --..... This Permit Expires 1 Year From Date Issued pate 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 with County Ordinance No. 549. (—X7-0 ...v �.. .... JOB ADDRESS AND L ATION.------`�-fom-D �Q TH------t9�E------ `----'`x'-- -`----------------11(Ate----------- Tf_!V.. kD Owner's Name ------- ..0_N---F-1------------V•---------N -t^"--------------------------------------------------- - Phone-- �`�5 $�--------- Address--------- ---- Contractor's Name- Q /J�-�------------------------------------------------ ------------------------------------------- -- ---•--- Phone-------- Pi�p�s�� . ,. Installation will serve: Residence Apartment House ❑ Commei= ial'❑ Trailer Court ❑ Motel ❑ Other ❑ prVVLj_lAlC— Number of living units: --)----'Number of bedrooms . Number oc. __. ft. f baths _ ______ Lot size ......_ Water Supply: Public system El Community system ❑ Privateth to Water Table ., h Character of soil to a depth of 3 feet: Sand ®'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date---------- ) No ® New Construction: Yes ® T4�] FHA/VA: Yes ❑ No TY_PE,OFY-INSTALLATION-AND._SRECIFICATIONS:,_. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well----�_..___---Distancp from foundation-----/Q-------.Material-_-_4�cfC , `----_---. No, of compartments - P --------- -Size-- --- - -l .-�X-5�-----Liquid depth----- --��--- Capacity---- fwell-5a Disposal Field: Distance from nearest _---Diff Distance from oundation_--_ p �Q____-Distance to nearest lot line_.._ '`�" . ._. Number of lines------- ____ Length of each line-50--+--L_ Width of trench........3-16_----.--------* - i Type of filter material...R.Q�,�___Depth of filter material g .._- ---___--- -----Total length - - -- --= Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____________ ❑ Number of pits----------------------Lining material-----------------------Size: Diame*er------------.----------Deptn----------.--------- -- --- --- �f Cesspool: Distance from nearest well-----------------Distance from foundation...-_-------------.Lining material--..--.-.- ----- ..`(] ❑ Size: Diameter.-- - ------------------------- ----Depth---------------------------------------------------Liquid Capacity_.- ------- ----gals. Privy: Distance from nearest well... ------`.__ --- --- --------- Distance from nearest build' g- El Distance to near lomat --(�] - Remodeling and/or repairing (describe):-, AE. --------OU S_ Z,,4��-------- �-----------------------------•-------- ------------ - ---- - --------------- 4 . ------------ F---------n��v-.-D-------�------ L == .. . I hereby certify that }-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. i (Signed) ------ ------------- ----------------------------------(Owner and/or or) _ _ _ ontrac ---- - -- --- BY� -- --- ---� -- -------------------------- (Plot --- ----- (Tit e} - (Plot plan, showing size of lot, location of system in relation to wells, uildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- TUR--Q------------------------------ ------------------------- ------------------ DATE----------�77//—_A_5 ---------------- REVIEWEDBY------------------------------------- --- ----------------------- ---------- --- --- -------------------------------------- DATE----- ---- I BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------- ------------------------- -:- Alterationsand/or recomm ndtions:----------=------------------- ------ -- ----'------------------------------------------------------------------------------------------------------- { /------------ ' �� r -n',----- b�[.G �--------------L.Ff._-:--l± 1�I.b ; I " ------------------- ------- ----------------------------------- - - --------------------------------------------- - - --------------------- ------------ ---------- ------------- FINAL INSPECTION BY----------------- ------------- ------------ Date---- --- ---------- - SAN JOAQUIN LOCAL HEALTH DISTRICT a` 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street "`�" Slockton,California Lodi,California ?x" Manteca,California- Tracy,California F.P.