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r . FOR OFFICE USE: -------------- ----------j R SANITATION PERMIT Permit No. --- ---- APPLICATION - O 0. ---- ---- -------------------------------- --- '(Complete in Duplicate) ------------------------------------------------ ,..,�,.,. Date..{slued ---•----- *-- 1 Year From Date Issued ------------ ,This Fe'rmittExpires'� D�O—jZ A ♦ F Application=is-hereby made to the-5an Joaquin .Local,Healfh.District,for,a per.mifi,to construct.and install the work herein de rite . This application is made,in compliance with County Ordinance No. 549. t JOB ADDRESS AVID LOCATI N.------- Owner's -- c �°(.�---- ----------1/�� ;� �a-------- - - Owner's Name----- --- --_- I -. Address-------------------•==- -•- /� �- I Contractor's Name_.- °R f--" Ph �{f. � a i Installation will serve: Residence Apartment I louse ❑ Commercial ❑ Trailer Cou rtt Q Motel ❑ Other ❑ !. Number of baths _-�_--- Lot size ,�C[ a -- --1 � ` Number of living units: _- --.- Number of bedrooms _- of .,, Water Supply: Public system ❑ Community system El Private $6 Depth to.Wafter Tpb _P ft. i Character of soil to a depth of 3 feet: Sand ElGravel El5aidy.LoamX.NClay Laam Q Clay E] Adobe[3 Hardpan E]I p ,New Construction;YesT No m F1iA/VA: Yes KA _No y 6 -.Previous-A lication,Made _(Ifryes,dae..,= •1 .Nq ❑ T TYPE OF INSTALLATION.AND SPECIFICATIONS: Y I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from founda-tion --- ---.Material__-..-.-_-----------._------- "---.__._.----. ❑c%xs-J1A)C N�. of compartments ....'Size.�w.�,....�„- ..........Liquid depth Capacity --.___-.Distance from foundation-----_--_.-_ _dstance to nearest lot line_--_------___-. ` Disposal Field: Distance from nea}rest well *---_i- rftrG Amber of lines-��-- '"�---�"� `�--- ----Length of each line------------------------� .Width of trench.--------------------------------- ❑ Cl p .: [,: r material-------- -f,Total length_.. T • e of filter materiai----.___..-.�---_-__.,--De .th of filte _ ` � � Seepage Pit: Distance to nearest well_--___-_A_--.Distance rim undation-- --- :Di'stance to nearest lot line-_�-------- Number of pits-.07 Ci- Lining rrieterial--- ---Size: Diamete 7?�a�fl�_XfQbepti�__ X-r4-X_.d-- 1w F.. Cesspool: Distance from nearest,well-,_-`-_�- --_Distance from foundation-------------- --- Lining material--------....___---_--------____---.--. t "'; I-__Li-uid Ca acit gals. I ❑ Size: Diameter ------------------- DePth---------------------------- --- - P Y r # .I .Distance from near t buildin 3 Priv Distance from nearest well ------------------------ 9 Y �....._ . 1---------------------------------------------------------- i ❑ i -- ,t Distance to nearest lot lne.__+_-___"------..---"------- --- Remodeling and/or repairing (describe;l: --- - --- + ------ &4 -----------------------------------------------------------I--------- -------- ----- ----------------- ------------- ----- --- ------------ --------------------------------------- -------------------------------- ------------------------------------------------------------•------------------ hereby certify that I hav 'epared this application and that the work will be done to accordance with San Joaquin County I ordinances, State laws, and rises nd regulatio of the San J quip Local Health Districfi'. 7�-(Owner-and/or-Contractor) ned - - - 4 -(Title)--- w------- -- . A- bY:---------------------------- (Plotplan, showing size of lot, location of system in relation to wells, buildings, etc., can be. platePonreverse side). B F9R DEPARTMENT USE ONLY I / APPLICATION ACCEPTED 8Y_. DATE --~ ''b -b� - - --------------- ' BUILDING PERMIT ISSUED---------------------------------------------------- - ---------- ---------- DATE----------------------------------------------------- ---- REVIEWEDBY------ ---------------------------- ----------------------------- ------------------- ---------- ------------------------ --------- DATE--------- ------------------------------------ ------------ Alterations and/or recommendations:---------------------------------------------- = -------------•----------------------------------------------------------------------- --------------------------------- ----------------------------- - ---------- ------------------ ---------------------- ------------------- -------------------------------- ------------ ----- FINAL INSPECTION By,,A;4_ Date--. -- -�.f`,1.._ //... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California 4