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FOR OFFICE U5E: --------------------------------------------------------- ON FOR SANITATION PERMIT Permit No. ..... --------------------------------------------------------- (Complete in Duplicate) Date IssuedThis Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dgscrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ND LOCATION.-- ,�l I�?.l_ _1 -FZ _ = 2— ''`'*-� �------ --------Arc,4_.--------rz -------- Owner's Name---------------------- ------ .- - -- � -�-- ----------------------------- ---- -. Phone------------------------------------ - --------------------------•--•- -- 13 ` � �r� � �Address............. .-- --- - -- c�-------------------------------=----------------- ------------------------------ ------- Contractor's Name------ -P4"__C__ ---------- ------- ------------------------- Phone-----------.------•---------------- Installation will serve: Residence �artment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-I----- Number of bedrooms -2—Number of baths ../-. Lot size ....�`. �} --------------- Wafer Wafer Supply: Public system ❑ Community system ❑ Private R-16-epth to Water Table __.?-. ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay [❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No New Construction: Yes•Ej`f�o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted"if public sewer is available within 200 feet: - — Septic Tank: Distance from nearest well-_-.5 5__Distance from foundation_------------------Material...�M2_R.E No. of compartments......--7 .......Size.-e___._- .p. Liquid depth... .. _._--..Capacity. Q Disposal Field: Distance from nearest well..., 0.-.-Distance fl�ation--------------------- nce to nearest lot line-----------------fi( Df Number of lines,._._..:..----------- Length of each line--------7 Width of trench--------...-..r...---. `-- -PZ t� Type of filter material.__ Q_ _.Depth of filter material---- �T...-.-..-.Total length------------ -w---------_ -.--.- T.Ro Seepage Pit: Distance to nearest well---------.............Distance from foundation..-----------------Distance to nearest lot line--_-.-.---.-.---_ ❑ Number ofpits------------------ ...Lining material-----------------------Size: Diameter---------------------Depth--------------------------------- A Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material----_--------------------------------V► ❑ Size: Diameter--------------------------------------Depth-------------------------------- -------- `------_Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------- -----------------------Distance from nearesf building----_--------_------------------____.__ - ❑ Distance to nearest lot Gne------------------------- -- - --------------- ------- --------------- -------------------------------- ---------------- - g Remodeling and/or repairing (clescribe):-----C;P-PA66_�__.- ------7 2......-Ig-0-0------ .4.. NK - ------vAFii-F_-f>---------�R°�''�----------2y- `` � ,r ------ N-rtzgc--,-----Pit t---------------- 5 --------F�-1 Park`:-��------.5t31-fb7.- - ....-.CO.N_Q-t.Tl-4�t�( -------M1�Dl=l ---- Ute"--(-r-O-E ---------=Tz_-j-E7N_c_t7------�k_L--T).........1?1__FFe_C_L L1 97...`.... ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and I'ations of the San Joaquin Local Health District. 100 0, (Signed) - = C' - ------------------------------------------------------------------------------- (Owner and/or Contractor) ...-$Y -•-------------•-=-------�-------------------------------�_---------_-----�-------------------------------=-------- - ----Ti#a --- -------- - - - �- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - c DATE l "___/------ e_ ------------- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE---------------------------------------------------------- -- Alterations and/or recommendations------- ------- ---------- --- -- -- ---- ----- ----------------------------------------•-•-------------------------------------------------- ---------- ---------=------------------------------ ---------- ----- Qt5------- ---------------------•---•---- --•---------------------------------------•--------- ---------- ----------------------------------------------------------------------------------------------------------•------- ------ ------------------------------------------------------ --- ----------------------------- FINAL INSPECTION $ ! Date_- - JOAQUIN LOCAL HEALTH DISTRICT 1601 E.-Maselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co.