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FOROFFI FUSE: f ' 'r/, 7 r lv - .3 �_ - .. --------------- ------ -------- .-.-_---_-_-___ �� ' .___. APPLICATION FO'R SANITATION PERMIT Permi+ No. ..�_:..__jt...... �� 3 -----------��V � ---- '-- iA ------ (Complete in Duplicate) � -----________r #..�`` _ _�'_(_,.._... I - This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance y1th County Ordinance No. 549. fd3 _ MC r� 0 �l .lr r�,uul�4 26 7 JJJ�� JOB ADDRESS AND�LO�CA ION-------��".�7 J------- r�X -?fv---"'------.�C�.-!/ 4BN- - $.rl�l __lid: 'DP------- •ETm L�' Owner's Name-------------y,.-------Cle 4--G-+-� -----------------------•-------------- ------- - -------------------------------------------- Phone:f' -�S-' - Address----------------------- T l y 4- ��.2-�s�-'--------- �7rO�fe�T"�silt' Contractor's Name ��.e4_ A.--,i '_ ---- Phone--- Installation hone--Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ M400ttel ❑ Other E] � Number of living units: ---/--- Number of bedrooms _�__ Number of baths _ Lot size .-_-.�7.�:� 1.G" ""__.-______..._._ Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table 4A,�-9 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [VClay ❑ Adobe ❑ Hardpan ❑ f1'1 Previous Application Made: (If yes,date..-----_---_--.--) No [�1' New Construction: Yes ❑ No 0' 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-----------------Distance from foundation--------------------Material _--___---_.-"_""..__-_....._---.-- .......".-.. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------- --------Capacity----------------------- 3 Disposal Field: Distance from nearest well.. .75' from foundation-__. fQ____.._"Distance to nearest lot line../G!�...... Dll' Number of lines.......... ......... Len th of each line-_.-_ ' °1 g - - ----- ------- Width of trench.-� r Type of filter material_-. _Iiav �-.Depth of filter material.-/r_"_---.......Total length---_-' ---------... ---------- / / Seepage Pit: Distance to nearest well__ ?.ft__Distance fr m foundation-"�d....._...Distance to nearest lot line---�------_"_ [r- Number of pits-------/---------.-.Lining mate rial-_A. �P .---Size: Diameter---_Y-5'r------Depth--.--m'I.�__1..._______.~ Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining.material__-_-_---------_--_-.___.-___.-.____.. Size: Diameter---- ------------------- ----------Depth------------------------------- --- ----------------Liquid Capacity al$. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------- --` ❑ Distance to nearest lot line..--- ----- ---- �--------------------••-•------------- - Remodeling and/or repairing (describe):---.--.- -7 �a____-_" ./A!_---------------- ----------------------------------------------- ."__._.. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State rules and regulations of the San Joaquin Local Health District. (Signed)------- --�----t� -s-�j----' /v�� or and/or Contractor] BY=---------- - ---------- ----- ----- ---- - - .......... --------------------------------------- (r+le) - - -- ---- ----------------------- --- ---- --------- (Plot plan, showing size of lot, locat' n of system in relation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------- --------------- DATE------ --`r -~------------ REVIEWEDBY------------------------------ -- ------ ----- -------- ------------------------------------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------ - DATE------------------------ -----...---- - - ------ Alteriations and/or recommendations:--------------_- --- 1.�� '' tiv �/' '--- -------- ----------- F- �. -t -------------- -- d I 6 -------------Z- ��x�_y - `° G' - -----'�---- ------------------- /1✓�--- q 4 t �Lf�'� t ! 2 r -------- -""- '"- ----------,-------- ----- ------------------------ �'l'-p�f-----"--=---------------- ---- =�'-1 �--`-�---�"� 4 ------------------------------- - FINAL INSPECTION BY-- ----------------- -�----- rJOACQUIN --��------ Date. - --------------------;� --- - - SA LOCAL HEALTH DISTRICT 1401 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California