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JOB ADDRESS AND LOCATION 4 L <br />Owner's Name If OA 6EP14 4.1 Phone.,741-.430 7 <br />- -plication is hereby made to the San Joaquin Local Health District for a permit <br />s application is made in compliance with County Ordinance No. 549. <br />.2—S. 2-24 Al A, y , <br />APPLICATION FOR SANITATION PERMIT <br />This Permit Expires 1 Year From .Date Issued <br />.e gi24,d -- -+ .miie so A of calleie .8 <br />, (Complete in Duplicate) <br />to construct and install the work he(&i descr ed. <br />007 - 260 .--19 94 <br />Permit No. ........... <br />Date Issued ..... <br />Address 0 ft,1_,E147 .4,9. t C4-Id <br />Contractor's Name 4 WA; fie Phone <br />Installation will serve: Residence tki Apartment House 0 Commercial 0 44wiien.romiwit Motel 0 Other 0 <br />Number of living units: .•t... Number of bedrooms _._Number of baths Ai Lot size /6.0 X eetl' <br />Water Supply: Public system 0 Community system 0 Private X. Depth to Water TableaWft. 52' -ST <br />Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam 0 Clay Loam 71,, Clay 0 Adobe 0 Hardpan 0 <br />Previous Application Made: (If yes, date ) No ig. New Construction: Yes g No 0 FHA/VA: Yes 0 No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: _ _ _ •••••••• .--, ••••••F -.^.1•111.... . — '.. <br />(No.septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank: Distance from nearest well.a.ST__ Distance from foundation./. ir. _ Mat? rial...aial 0 ed <br />X No. of compartments a. Size. 3.X.S7X, 9 .. Liquid depth._ ,ef., .4" Capacity/O4/S. ki <br />Disposal Field: D;stance from nearest well .5-6_07.Distance from foundation..../(147.....Distance to nearest lot lid5e....57.-FIZ. <br />St Number of lines ---2_, / N ,04 Length of each line. ...,V_O V" Width of french. a9 <br />Type of filter material_.kice....Depth of filter material../e" Total length.. 41061,' <br />Seepage Pit: Distance to nearest well../ 0-1, Distance from foundation 1,3 ' Distance to nearest jotilee <br />A Number of pits. i--. .Lining materiaL" ..,' Size: Diameter.4,- '1/ Depth.."- ' <br />i Cesspool: Distance from nearest well Distance from foundation Lining material <br />0 Size: Diameter Depth Liquid Capacity gals. <br />,vy: Distance from nearest well Distance from nearest building <br />El <br /> <br />Distance to nearest lot line <br />Remodeling and/or repairing (describe)• ovexci sr ys22 W T4//e <br />I hereby cer "fy that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, Sta aws, and rules and regulations of the San Joaquin Local Health District. <br /> &L/ <br />. —•ern. <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY... <br />REVIEWED BY DATE <br />BUILDING PERMIT ISSUED DATE <br />Alterations and/or recommendations: <br />ciNAL INSPECTION BY: <br /> <br />Date <br /> <br />(Signed) <br />- By- -- <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> (Owner and/or Contractor) <br /> DATE /0 . <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. ilasolton Ave. <br />.""itockibn; California <br />300 West Oak Street <br />Lodi, California <br />124 Sycamore Street <br />Manteca, California <br />205 West 9th Street <br />Tracy, California <br />F.P.C13.