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7R,OFF[CE US E: APPLICATION AOR. SANITATION PERMIT Permit No. -- ----------------- ------------ ---------------------- (Complete in- aDuplicate) ----------------------------- --- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the ly� here described. This application is made in compliance with C ty Ordinan No. 549. f'?io a" T " „ - ------- - -- ---- - - - ---= - ✓_. i JOB ADDRESS AND t0 ATION___ ____,__.._________- _*___ _ Owners Name_ �- �' _LtglT- = � -------------------------- --------------------------.-�Phony r a Address '��' ,= jj _ --- -- 'Jho J � G Phone--- Contractor's Nam _i,,Q__-- -- -_-- _ � �� C��,7ell ----- Q�.s �C'�— -------- =-�?0- /-•_ Installation will serve: Residence partment House CommerTrailer Court ❑ Motel ❑ Other ❑ r Number of living units: -1.____ Number of bedroom Number of baths _l_._ Lot size ____ lo Water Supply: Public system ❑ Community systerr-jk':O`Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand.E] Gravel. Sandy Loam Clay Loam E]lay y E] Adobe E] Hardpan E]Previous Application Made. (If yes,date___�___---,--.-_"-} No ❑ New Construction: Yes o ❑ -FJ./VA: Yes 9?--"No ❑ { E. ;TYPE OF INSTALLATION-AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within 200 feet.) Septi Tank: Distance from nearest wel ---�__Distancefrom founcIp i�_ .le __.Material_`=__ ______________________ No. of compartments_' _-_-__-______Size_ _ _r 1_7 _ i�uicl depth. --------Capacity-, t? Disposal Field: Distance from nearest well___ - `Distance from found n Distance to nearest lot liner (/ _ t Number of lines________ _____. _ - __Length of each lin --�--_-- #__._.Width of trench___. ______________� Type of filter mate: _Depth of filter material____l� __--_-Total length__________________ _Q______ v[ t Seepage Pit: Distance to nearest:well______________�g __materiial Distance from foundation_____________-____.Distance to nearest lot line----------------- ` ❑ Number of pits----------------------Lini ---------- ---------.-.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----------------------- -------------------------------------------------------------------------------------------------r-------- Remodeling and/or repairing (describe):------- ------ -- ----------- -----------------------------------------------------•-------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I_hqve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and/ es and regulations of the San J uin Local Health District. s,� aL ,y & nigh (Signed)----------s-EF I0- rA11K---SMRVtCM----------- --------------- Contractor) BY 29]5 LMnetAve., ■ HO.6 -; ' (Ti+le) ------------------------- ------ (Plot plan, showing size of lot, location of system in relation wells, ut ings, 9C, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________________ _ { �. DATE-__________._ REVIEWEDBY--------------------------------------------- -- --- ------------- - - --------------------- - ------ DATE--------------- . BUILDINGPERMIT ISSUED-----------------------------i-------------------------- ------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations--------------- ------ -- -------------------------------•--------------------------------------------------------------------------------------------- ----------------- ' `3---(�6--------Mt��------T�_L�A-�LC�_u_�r�} 5�� j�5T�1�1 1�11�95 1NSTAL.1ED 7ij1 5.-------13_5.EE.n(--------LUOA)4_//V-- ---�A7i5 A-crO-P,L6y—_7.... W - _.. I/V5 YD`r- 5UR-E�- -Fal .- - C 14 CT-.- -l_YDV-�------13-V T--- `�-----------S141�_� �ZV-----��5---------01-K �-------- -- P r T 5 I N-Srp L c-E<i�. mA' -4,q v E - E1 jN5PECTI<D Ry 5F}Ni,rA KI A;d FROM STKN OFF(L� �_C7 FINALINSPECTION BY------------ ----- ------------- - --------------------------- Date-------------- - ---- ------- ---- ------------------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockfon,California Lodi,California Manteca,California Tracy,California