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--' .. .. . ....... ..._..... sT Permit No. J t - P IICATION FOR SANITATION PER •--•---�t•---• (Complete in Duplicate) `' /t S This Permit Expires 1 Year From Date Issued Date Issued ....... . (..t' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance N(/ with County Ordinance No. 549. ) iA T f"I F_0' 1 _. JOB ADDRESS AND LOCATIO ...E&P........F EL�.laR-r.......R�---- t-------5;_-...:....R.L.q_EF�.....------. Owner's Name.................... .......... S :i.........................................._...... Phone......_.................--^--_... �h � & Address.-----1.5-7y1------JE-------ky . ,........CALI.F:........ ...... .......---....... Contractor's Name....a&.WA'ZE--,.-.,................................................_... ..............-....................----....... Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Kt�,Motel ❑ Other ❑ Number of living units: /L.. Number of bedrooms ........ Number of baths ........ Lot size _13--/ka ................._..... „e Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -5. ft. Character of soil to a depth of 3 feet: Sand ff' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date....................I No Q' New Construction: Yes a- No ❑ FHA/VA: Yes ❑ No Q" 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.....SO.._.Distance from foundation......10......-.MateriaLl.L. L .' '4�%1�................. No. of compartments.-.....�- ..........Size..�J�.-.X..�--?r-- X-.t'cx-Liquid depth.-_S--_---...---Capacity...3.�'!'�c-- Disposal Field: Distance from nearest well---.50....Distance from foundation.....10........Distance to nearest lot line.. y Number of lines........... Length of each line. 30..!7EI.C.0...Width of trench........ ._.......... 4 bee Type of filter material...R.C.CK....Depth of filter material----.1cf?............Total length------------ C..--t7K •_ --... ' Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line-------r!F:e-- ❑ Number of pits......................Lining material.......................Size: Diameter..............a........Depth.......................... ....-.. Cesspool: Distance from nearest well.................Distance from foundation.._-..............Lining material............-................. ...-... E ❑ Size: Diameter_..................a................Dapfh_...........................a.....................Liquid Capacity.....- ....................gals. M .......--..Distance from nearest building , Privy: Distance from nearest well..................................... g--.-.-...-..-.._..-.--...-...-..-.-...... ❑ Distance to nearest lot line.........................__........................................................................................................ Remodeling and/or repairing (describe):------ -1,,FA .L-.(.-...-41.N1P LlM .... .665=7 .................... .........----............. .......... ..............................................................................................._......................................_71R-01 -----'-----•---•----.......... ........... ............................. ......... ......-................................-..--......-..--.-......-------------.................................... '---........... ..........---......--.--.._---------...--............................---...-..---------� reby certify that I have prepared this application and +ha+ the � rk will be done in accordance with San Joaquin County mantes,State laws, and rules and regulations f the San Joaquin Local Health District. .` (Si ed)---i`"'-'�-.-- --�--•--------- ---- /--- -------------------- ---.IOwner and/or Contractor BY°.....................,-......----.....................................--------------------------- ------ `--------------(THIe) ------ ---- _..._. - .Jpt plan, showing size of to+, Iota+ion of system in relation to wells, build, s, etc., can be placed on revere side). -- FOR DEPA USE ONLY APPLICATION ACCEPTED BY-...... -. -..--Q..-:.._...... ..........----------......-....................... DATE_..........5...'I�.-.q.S.... ._ . _ . REVIEWEDBY........................................ ................................................................................. DATE.................................---------------------- BUILDING PERMIT ISSUED..............................................................----......................., --- DATE............__............-........---------........... Alterations and/or recommendations:........................................... _......................................................................................----------.............. - ----------.---..............------------------•------------------------- ------------ ---------------------------------- ..---------------- . *....................^ ...... .................... -- ..............._.......................... ------ _...... .-... --- ......- - .. _....... _--.-.-..--.-... ........................................:............. ..:... .ri............. . ...-..-.-............ ... .........-........-.-..-.....---......-----......... ....._------- d FINAL INSP . . ��n . . ..._... .... „skC%�/ Dete....... ....... - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasdton Ave. 300 Wast Oak Street '- 124 Sycamore Street 205 West 9th Street Stockton,California _ Lodi,California Manteca,California Tracy,California F.P.00. r