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--------------------------------it---------- ------ -t-LICATION FOR SANITATION PE'h.atf Permit No. _ae,3:�_!___p 1 ..._"------------------------...................--...... (Complete in Duplicate)-Y : _._ ------ ----------------- --- This Permit Ex fires 1 Year From Date Issued Date Issued<_5__-�.�r__- � Application is hereby made to the San_ Joaquin Lotal He District fora permit to construct an !� d install the rk• erem es ribed. This application is made in com li_anc with Counjj Ord' ante No. 549. �; � J08 ADDRESS LO ATION _ _ _ -- Owner's Name------------------ .� . s----------------- AddreAddress-------- ss-------- 'OV4 Contractor's Na ------- ----------------------- Phonal - f . Installation will serve: Residence ❑ Apar#mt Nouse ❑ Commercial ❑ Trailer Court ❑ Motel E❑ Other _ , Number of living units: "-_f__- Numbs ofbedrooms"� _ f Number o aths -_ �, _ .� I Lot size Water Supply: kublic'$system .❑ Communify,system ❑ 'iv e Depth forater Table -------- ft. Charade of soil to a depth of 3 feet: Sa dtav�l ❑, Sandy Loam Clay Loam ❑ ClayAdobe amend an� �r:.w,.+' Y ,,,E,• � 3 ❑� LST" h p ❑ Previous Application Made: (If yes,ddte?.___... ';! rJNo E] 11 Yes ❑ No� FHA/VA: Yes ❑ No Q,,, TYPE OF NSTALLATION AND SPECIFICATIONS: r_� sceptic tank or cesspool permiftecl if ppublic sew_W is available within 200 feet.) ' 0'. Septic dank: Distance from nearest well _Distan Distance from found t' ��._-____.Material__. �Capacity.___ -/� g rNo. of compartments_1CI_____ ____________Size.3_.►�._ �_ _ [ piquid depth. _��__--_, - d" / I 7` AD Disposal Field; Distance from nearest well. (�l�`Distance from founda ' n-.�+/_-------.Distant a to nearest lot line____ Number of lines__ ___ _ ._ ._._ - Length of each line_-e0-_____-0 . -___-_".Width of trench --- --- -- --- p f r ype o filter m�fierial____ ' � e th of filter material_...__ ___ Total leng�th-------------------- : Q"""--_"_.- -"__ Seepage Pit: Distance to nearest well-------- Distance from foundation___________________Distanceto nearest lot line----------------- 1-71 ' /// t� Number of pits-I..___ ._"------ Lining material_________ ________Size: Diameter_------- Depth-------------------------..___--- Cesspool: Distance from nearest well __ Distance from foundation-__._-___._--- __.Lining material_"_.-._-------------------------------------- ❑ Size: Diameter - --------------- -----.Depth-------t---------- ---------------------------------Liquid d pacify----------------------- gals. Privy: Distance from nearest well.'-;-------------------------- -------------------Distance from nearest building ❑ _ ".Distance to nearest lot line - ------------------ ------------------------- ------------------ � ---------------k----------- ------------ Remodeling and/or repairing (describe):__."- t t. ----- ------------ --------------------------------------- -w------- ------ - -------------- ------------------------------------------------------------- ------------- ---------------------------------------------------------------------------------------- ------------------ -------------------------------------------------------------------------------------------------� :'------ - .I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County IS, ordinances, St to is s, nd rulerand r gulafions of the San Joaquin Local HeaXD' . _ Signe - - ` A( d ---- - y ' -' '- r_ racfor ) BY= -------•- ------------ k � t Title (Plot plan, showing size of lot, location of system. in relafio o ells, buildings, ; c., can be placed on reverse side). �i FOR DEPARTMENT USE ONLY x APPLICATION ACCEPTED BY----------f""_ " a -------------------- DATE -- ---------------------- R'EVIEWED BY - " ------.- - -- ---- DATE---------------- BUILDING PERMIT ISSUED-------- -------------- :------------------------------ ) ------ DATE , ------- - --- `Alterations and/or recommendations:._° = ----------------------- --------------------------------------------•------------------------------------ ---------------= --------- ... _1-. -------, - ---------------------------- 1 ------ - ---------------------------------- --------- t FINAL INSPECTION BY:__ Date---- - -- �2_ i SAN JOAQUIN4LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave' 300 West Oak Street "�124 Sycamore Street 205 West 9th Street 1 Stockton,California dk Lod;, California .... Manteca,California Tracy,California . 111 � r