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FOR FFICE USE: r 7 {{a j, _ _ _'___----.- --.---- APPLICATION COi. SANITATION PERMIT Permit No. ��. (Complete in Duplicate) _f Date issued ___ 7 ___ ___--- ---- _...... _----------------------------„-__ � This Permit Expires 1 Year From Date issued"` Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION / 4a __ -6-G �'�f' ------------------------------------------------- Owners Name 2'tfs W---------------------------- ------ Phone-. �.. O Address................ f1-'l._------------------------------------------------ ----------------------------------- ----.----- Phone----------------------------------- Contractor's Name-- --- -------- / Lle't------- ---------------------------- - ------- Installation will serve: Residence M'ipartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms_ Number of baths _f___ Lot size ........S7P.__ __, a.4___...................... Wafer Supply: Public system INI-Community system ❑ Private ❑ Depth to Water Table .7Uft.�OlaX Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B,�-Kardpan ❑ Previous Application Made: (If yes,date._.------____ -...) No jig New Construction: Yes �o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �1 Septic.Tank: Distance from nearest well----------------- from foundation--------------------Material---------------------------------------------------- � No. of compartments--------------------------Size---------------`----------------Liquid depth----------- ---- - ------ Capacity------ -------'----- V Disposal Field: Distance from nearest we1..1VQl7G_Distance from foundation---- Q __._____Distance to nearest lot line------5_______-_ ry Number of lines------------- —--------------Length of each line_34_-._1/!0__.. Width of french--------pg_"------------------- ah __________________Gh�irde� Type of filter mate ria J9Fr&11RC4_Dept h of filter material--------I&----r..Total length-------------- 'd____________ ---------- Seepage lam: Distance to nearest well-- ------Distance from foundation------L0-------Distance to nearest lot line---- .___.__ -&y dumber of pits----------I-----------Lining material----P—OC-4----.Size: Diameter....YX4!........Depth_-__-_._Af----------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------------------------------------- El _-----------_____.❑ Size: Diameter- -------------------------- --------Depth-------------------------- ------..Liquid Capacity----------------------.._-gals. Privy: Distance from nearest well----___------------------------------------------Distance from nearest 6uilding.----..___.__._______________..___..__--- ❑ Distance to nearest lot line--�--f-- ----------------------------------------------------------------------------- --------------------- ----------- remodeling and/or repairing (describe):---------X_ 06 /.i^d�! -�,rfr � _ ry_x1crAw_ I --------------------------•---------------------• I------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- - ------- --- --- -- 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, and rules and regulations of the San Joaquin Local Health District. (Signed} ---- ------------------------------------------------------------ -------------------((Owns and/or Contractor) • - ---------------------------------------------------------------------------------------------------------------------------(Title)------ ------------- -- - (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY oll APPLICATIONACCEPTED BY----------- '------------------------- ------------------------------------------------ DATE-------�'� --------------------- ---- REVIEWEDBY----- ------------------------------------------ --------------------------------- DATE- BUILDING PERMIT ISSUED---------------------------.-------------------------- Alterransan or recommendations:-------------------------------------------------------------------------------------------------------------•--•-----•--------------------------------------- . - z �---- - ----------- -----------------------------------------------------•-------- --------------------------------------------- FINAL INSPECTION BY:--------lell"--------------------------------- ---- ------- Date--.-----7 / !`7 --------- ----- ----------- ---- -•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California a.. 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