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FOR OFFICE USE: _ � '------------------- f .. .- __-, APPLICATION F(5R SANITATION PERMIT Permit No. l/--� -- ------------------ _4=4 ------------ - f _4=44--.............. '�' -, . _ (Complete.in Duplicated Date Issued `s27_=9 �� This Permit Expires_l Year FromDateIssued y Application is h�ireby*made to the-San Joa uin Loca€'Health District fora permit nstruct din the work rein described. This application is made in compliance with County Ordinance No. 549, �f Y /J � JOB'ADDRE55 AND LOCATION. N O�4L� P"X ---- ----- tt� .S�................ -- ----------- ------------ ----- --- Phone fi Owner's N�a'me----- ¢' E_. z _yy. .t3'Q x l.aw_,Ig C,-,#.- -------------------------------------------- Address_______________ l r Contractor's Name----------— .1-..-----i-Al-C-A------------------------------------------------ --------•------ hone i9 �� *Jv ' Installation will serve: Residence ❑ Apart-ment Housel❑4Commercial ❑ Trailer Court ❑ Mot 61 ❑ Other $3 TRA14ZW t ' _ Number of baths Lot size . -Q-- --•-------------- USS Ho Number of living uni�: 1 Number'of bedrooms _ I-- � ae r .der � +Ike k Water Supply: Public system ❑ Commun'ity system ❑ Private 'k Depth to Water jable��Q ft. Character of soil to a depth of 3 feet: San 6 ❑ Gravel'.n Sandy L am' "D A Clay Loam K Clay ❑Il Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date...... ....:........} ' No New Construction: Yes`�}tNo ❑, FHA/VA: Yes ❑ No TYPE OF INSTALLATION ND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within24011feet.) IT Am f Se fic'Tank: Distance from nearest well..$...---Distance from foundation-.. 1�'�-.Material.......... ................. ... p - � rr No. of compartments----�-- ------------Size-3--X--'--------------LigA cie�tli__�.� _-Z ----Capac:tY---�p©-��`� r Disposal Field: Distance from nearest we€I_bQ--------Distance from foundation_-f g_.-------.Distance.t nearest lot line.- -------- DisposalkA L•ength�of.-eachTlinerf I�U �Wid'thof=trench-----`� --�--------------•- Type lof filter material Depth of filter material-------- _.r--_-Total leng h.....-__.. ----------------_---. 4) N Seepage Pit: Distance to.nearest well.../p_ _'_...._Distance fr m f ndation__ ��.._.-__.Distance to neardst lot line.....-.._- : : Number of pits-- -�l.�___Lining material--- Size: Diameter.- 3- -� --- Deptn_.-_w�+✓--i............... j Cesspool: Distance frominearest well---------------- Distance from foundation____....-._-----_Lining material.....-._.___......__--......___-..... ❑ Size: Diameter---- --------------------------------Depth------------------------------- ------------- Liquid Capacity as Privy- Distance frominearest well-------------------------------------------------Distance from nearest building--------------------------------------- . ❑ Distance to nearest lot line---------------------- --------- -------------- ----------------------- -------------- ------------------- ----------------- k .. I Remodeling and/or repairing (de tribe):..- -- .. �2.412 L - ! ---------------------------- - --------------------------------- ---------------------------- -------------------------------- .............. .......... ............... ..................................................................................................................... ...... I hereby certify that I ve prepared this application and that the work will be done in accordance with San oagtiin Coun y ordinances, State laws, a les and regu tions of the San Joa n Local Health District. (signed) - (Owner and/or Contractory -- -- --------- ------ --------- ------------- -- By:----------------------•-•------------•-- ------------(Title) ------ . (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be plat on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - -------------- G y�� DATE----- REVIEWEDBY----------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------- -- ------------ DATE--------------------------------- --------------------------- 1 Alterations and or yecommendaf ions:--------------- --------------------------------- -------------------------------•-------- ----------•-------------------------------- 3 � � ....-.. _, -y..- �^ /} -------------- ----------------------- ------------- --y-..�__ ._--.----�_J � ----- _.��.{;�-.�./� .. .__ .t a'-.K�_ !*IK+-a� --"��V4.�t"--..-....-.. V •�-S_ ._ ' � __T ----------------------------- ?�..:'. .� ----='--f--- ----------- -- ------- ---------- -- ^Sf2 -. =r-- --::�`-`- �c..--"----- ------------ FINAL INSPECTION BY:- .... �-�----------------- ----- Date...... -- - fr'------- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT - 1601 E.Hazellon Ave. 300 West Oak Street, 124 Sycamore Street 205 West 41h Street Stockton,California Lodi, California Manteca,California Tracy,California F.F.ra. }