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FQ ,SjFFICE URSE: _ > y :.. r --------------------- "____ ___________________ APPLICATION PU'R SANITATION PERMIT ' r Permit No. 4 ,7�. ----- --- ---------------------------- --------------- (Complete in Duplicate) ----------- ----- ------------------------------ -- --- This Permit Expires 1 Year From Date Issued Date Issued O�II Application is hereby made to the San Joaquin Local Health District for a permit to constructa d install the wor hereip described. pThis 4application is made in complian a nth County Ordinance No. 549. 1+/i'Tr J� I JOB ADDRESS AND LOCATION- --------S-f-DF------URTH-------PVH---------� 0 w-i Owner's Name-------------- -----------�---------..T3_ _�0_t4j------------- ------------------ ------ Phone---•---------------•---•--------•-- Address....•----------1/- -----------��.f�_f�4_-�--------•-�--�-----------------------M-��-0----f----- --�-----&A------/i-�aa;g_.�'-._..___- Contractor's Name----OWA FR�- -------------•---•--------------------------------- ----------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms Number of baths ---/-- Lot size .......AC T�_CM,r_ _______________________ Water Supply: Public system ❑ Community system ❑ Private 2---D',pth to Water Table -_2-K ft. Character of soil to a depth of 3 feet: Sand E Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (It yes,date_._..__..________) No © New Construction: Yes ❑ No �FHA/VA: Yes ❑ No E- CIO - TYPE OF INSTALLATION AND SPECIFICATIONS: "�""r{NoTseptic tank or cesspool-permiWed-if public sewer-is avadabie within 200 feet. ' "'f Septic Tank: Distance from nearest well____s _0. ----Distance from founda,tion__.__ Ma erial-� _[ .{= f_-- --.-----. c-- No. of compartments_.____. —.----__----Size-- xm_y__ ..___Liquid depth.___.�1-2 .____..Capacity_./ZPjP----- hl 1: Disposal Field: Distance from nearest well---- ..__Distance from found ation____10._____-Distance to nearest lot line-----5__.___... Number of lines-----------2.---_______________Length of each line---�10__--A:___7Q_-Width of trench----------- Type of filter materiaL__P4C - -,L.__Depth of filter material___.._ ..F .._ Total length----------- Seepage Pit: Distance to nearest well------__--------------pistance from foundation--------------------Distance to nearest lot line----------TtR © �. 171 Number of pi#s_______________------Lining material-----------------------Size: Diameter------------.----------Depth--------------------------------- 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__.___.__.__._________._._ t -- ----------------------------------------------------- ------------------------------------------------------- 10-26-iG� I Remodeling and/or repairing (describe):__.___39ftNDOvv4 _.__ Ft S---- T-__-_ (f}S_---�1[ ,----ZTt;7-_-.�1(�.j�--__1? r._ _ ------------ F.•----AFACt(-- 41VF- 7 M_ --------FAN S-N ----'B-T-------417-..........WAS �1-------13 FORM------- Pse—vont-----^--------7-/-- WA fit . 1 ---- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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)________ ___ _----____ ---__------ --- --------- - -- (Owner and/or Contractor) -- ---- BY: -` -- -------- ---------- .. -{Tit.e) - -.---- �-- . . --.-:--_-- �' (Plotrp7an, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ter-- r APPLICATION ACCEPTED BY----- - I ',��_ ------ ------------- - ---------------------------------------- DATE----- �� -------------- REVIEWEDBY----------------------- -------- ---------------------------------------------------------------- DATE------ ---- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---10--70-4s........ M------,-IdE-____� _ ------- -------------- ALL Fo .._Fi..n[R�- 10 = s 7`R_ -------------------------------------- ----------- - --------------------- = 1i 1_�. D---------P[.... P r ------19T�`AS1-f D T�.f _d-' �Qr P?Qc.K-------Nr=C_Nr=c-------------------------------------------------------------------- --------------------------------- ------------------ -------- ............... - ---- -----. ---_.__.: . ------ ------ ------------I-------------- - ----------- FINAL INSPECTION . Da#e---------w-`._./� -------------------------------�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1.Hazelton Ave. 300 West Oak Street � - 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.0 C. Y