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- ------- ...................................... --- ----- ..__ -- - .-__. ANOoCATION FOR SANITATION PER"wtttf Permit No. 1Q`_ _..... .. ...... .___ . ---- ------ -- (Complete in Duplicate) _.. 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 work herein described. This application is made in compliance with County Ordinance No. 549. SCA ^, 1 JOB ADDRESS AN LOCATION �� C f't Il� �L---- T .1__N. �Z� �`---�------------------------- Owner's Name..__.��N.R� 0r _ s _ -------- Phone-----------------------•-----_----- Address r _ � �Ok �2 1 �`��A�- N _ _ - -------------•--.--------------------- r� Contractor's Name-�J(,111 .rGR _ �.... "RO_B. j.l�t`. . .- Phone _-. J. 7E- 2 - ook 24-6 Ric, .----------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Goan# Ed Motel ❑ Other ❑ 7 n � Number of living units: _ ..--. Number of bedrooms umber of baths _�.__._ Lot size ......... Water Supply: Public system ❑ Community system ❑ Private th to Water Table J.S- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan Q' Previous Application Made: (If yes,date--------........._.) No �ew Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t r Septic k: Distance from nearest well..-5�..__Distance from foundation.....j____--------_Mate r'al-_-__-- /1lO CR_F_TA�._ • No. of compartments___ _-_.. ...Size_3X0_X 5________Liquid depth.___1/ 7-- ------- Capacity--- Disposal Field: Distance from nearest well-50...._Distance from foundation_... Distance to nearest lot line_..._.__.__. 0� Number of lines---------- VIOCK..... Length of each line... . _ Width of trench....... .�..�-_ Type of filter material_-VIOCK_...Depth of filter material-----1__I- -----------Total length-....-_--_____.__�7.-0:------------- Seepage tt: Distance to nearest well_1P.0.........Distant from foundation._1?__-_.___-.Dista�f'ce to nearest lot I•ne..J-..._ .__ ----Lining materiall.... -..Size: Diameter.Z6,4x.. _.Depth l�--_._ ------- Number of pits.-_.._�..._. De tn..-_.- ____ -_--......_ Cesspool: Distance from nearest well.................Distance from foundation.............__.----Lining material......-_....____.__.___.__.-_.__._.-- Size: Diameter--------.-----------------------------Depth_..._..........._..__. ._...__..._Liquid Capacity gals. an Privy: Distance from nearest well.................................................Distance from nearest building._.___--_--_---____-...._. \ Distance to nearest lot line ..-.. - - ----------------------------------------------------------- - - - _ --------- - - Remodeling and/or repairing (describe):----Jys_►-_ �n.._. ...5-�A_C3 .D.......13'EoR�.....�S .Lr_f _l�!`.0 ......... q ----------- . - -------------------- - --- --------------------- ----- ------••---------•----- ------•-----------...----------------- .............................. -- -------- - -------- ---- - --------- --- --------------...T�_�-�. - - - - ----- --------- ------ - ----------- _ ------- ------ -------------- --------------- ----------------------------------- -- --... .. ...... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an les andr uI tions of the San Joaquin Local Health District. (Signed) --- -- ------------• . -- ----- .....-- ----- ----- ------- -------..(Owner and/or Contractor) ` z -- ---- Title ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). See FOR DEPARTMENT USE ONLYIN APPLICATION ACCEPTED BY.... 1.-c.-� ..�...... . - ------------- - DATE....... C` REVIEWEDBY----------------------------- --------------- DATE....................... --------•--•---•------------------ ` BUILDING PERMIT ISSUED---------------------------------------------------------- DATE-----------------------------....... ---------------------- Alterations and/or recommendations:--,//- ------.r)(AM--------FLL ....G?NA►_._.__Fmjl;�.�--_..R.� a t4j.---------- ........ 2,:------->B-CS -------- ,6kl---------- A. n - - -- -t O-T- - ----`t-F} 1. ...... °_..---- 1'-U -�----------------------------------------------------------- - ------- ........................ ..... - _......... .............................................................._......_...----...----------------------. . ---------- - ----- ----- .......................... FINAL INSPECTION G:. . ..... .. e. � Date..... .../.L'------- �.-... fes'. -- . . ------. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak street 124 Sycamore Street 105 West 9th ctroel Stockton,California Lodi,California Manteca,California Tracy,California ( ` F.P.CO.