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- ------ ------ Ar. (CATION FOR SANITATION PERt� Permit No. Y-L 3 <br /> L---------- ---------------------- -------- -- ~ (Complete in Duplicate) <br /> -------------------------------------- <br /> ----- ----- --- This Permit Expires 1 Year From Date Issued Date Issued 1_-_....__... <br /> LApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.._.-��/��..../'�- 141 .-__... <br /> --------------------------------------------------- <br /> Owner's Name...._ .LLL -----.lL�/ a ,e.`./d�.. .- -----` -----------. Phone................. <br /> Addres s- -'---------------- <br /> ---------------------------------------------- <br /> --------------------------------------------------------------.._..------------------......I--------------.............. <br /> Contractor's Name.------ ] � �-------------------------------------------------------------------------- Phone------. ----------------- <br /> Ins#allation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑,s Motel ❑ Other <br /> - <br /> © � - <br /> Number of living units: .'__ Number ofbe,,drooms Number of baths A_ Lot sizeola_.�,,�-_1���1. .___._......__ <br /> L ---- <br /> Water Supply: Public system ❑ Community system [� Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel Fl,,Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2aHardpan ❑ <br /> LPrevious Application Made: (If yes date___... ..._..._-) Now Construction: Yes ® o El FHA/VA: Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ( (No septic tank or cesspool permitted if public sewer is available withiq 200 fee}.) <br /> Septic Tank: Distance from nearest well.._sl.��.r.'_Distance from found�afJo7n- . ....'__..Matgria�.fv�. .'.'4 .�Y. ............. <br /> No. of compartments----- ---..---_.._.Size___y�.------��.5t-`-Liquid`liepth_.C�_..�......_.-__---Capacity./.�r..p..._ <br /> ie <br /> Disposal Field: Distance from nearest well....Ir ------Distance Distance from foundation:.��_...:_. ' to ce to nearest lo} line..._. <br /> -- - <br /> ®� Number of lines___._._�__... Q___. Length of each line_.fW�__..__._-..Width of tranch.�.........------------ <br /> Type .__.... <br /> of filter materia✓,Fp 'e <br /> - -- Depth of filter matenal_� ..___..�Ta(al ,length.-Z"� -'....__.___.-.._---- <br /> i � I <br /> L Seepage Pit: Distance to nearest well-_l1.p-----Distance frogT,.q fo ndation--,?a_....I_ 1s�t+nnce to nearest lot line_!9"._'__._ <br /> ®� Number : pits_-1_._.-.-._-.Lining material._,, pt _Size:;Diameter------ .--._.Depth.,e JS''._.._.___...__... <br /> Cesspool: Distance from nearest well----------------- from foundation. �kiilg material-----------------.-.-.----._.._.... <br /> ❑ Size: Diapeter.--------------------------------Depth------------------------- -. i Capacity <br /> L } 94+fi P tY ----•---------------gals. <br /> Privy: Distance from nearest well...--..-_---..-.._-----------------._._..-Distance from real st building---------__-----__.--- <br /> ❑ Distance to nearest lot line.. ----------- <br /> Remodeling <br /> Remodeling and/or repairing (describe):------------- <br /> ------------- <br /> L -- <br /> - -- - - - ...----------------- - ------------------------------------- rj----- -----------------------­ <br /> ------------------ <br /> - <br /> ------------- - - .......- - - - - - - - -----t--------------------------------------------------- <br /> L <br /> -------------------------------------------------------------------------------*r-°--------------------------------------------------'*------------------------ -------- <br /> L I hereby certify that I have_prepared_this applicatiori"altd that #he.work will be done in,.laccordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) - -- ` - ✓ (;4elaffion <br /> - oar Contract <br /> T <br /> - ------------- - <br /> ------- <br /> By:-------------------' A------------------------- -( itle) <-- - <br /> Contractor] <br /> (Plot plan, showing size of lot, location of system to wells, buildings, etc., can be placed on reverse side). <br /> L _FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - -� f---------------------_----------- DATE--!4 -3.=C`~1- <br /> REVIEWEDBY-._-----------------------_ -------------------------------------------------------------------------------- DATE-------------------------- - <br /> BUILDING PERMIT ISSUED - - - -- --------------------------Z---- <br /> - -I-------------- <br /> -- --------------------D----A-----T---- <br /> DATE - - - - - -- - <br /> Alterations and/or recommendations:__.'.-. .-�p....7...._..__1[.- J .__ .. G__----_-_-_-----_---_----- <br /> --------------------- <br /> ._- <br /> ------------------------------ <br /> -------- ----------------------- <br /> --------- ----- ------------------------------------ <br /> --- <br /> -------------------------------------- -- --- -------------------.--. ------------- <br /> G ...----------- Date-'---------- -� <br /> FINAL INSPECTION BY:- -. .._`_._�_. s; �..----. ---- - - - -- - --- - - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t <br /> Stockton, California Lodi,California Manteca, California <br /> Tracy,California <br /> F.P.CO. <br />