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FORs6 FICE USE: e APPLICATION FO SANITATION P � M]T, Permit No. ------------------------------------------------ - r -------------- (Complete in Duplicate) sDte Issued This permit Expires 1 Year From Date I„s..,_ - 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. 49. 'L2'? - C)2-0- V7 PsC-. �,DI M � JOB ADDRESS AND CATION------- ___ __6HQ_a'_J_-�----- BEuv-nn---------��------------------- QFRCF----- (�. _ -'--- --------------------- f.n Owner's Name-------- -- -- -- ---� - --- ---- -=------------- -- -- ---- Phone.-: ---•----------------••--•-----•- Address-----------------�� ------------ A C� �SC�/J------/4 V 1- ---- ��`------------------- Contractor's Name----fob*' f--------------------------------------------------- - Phone 9 -- ----•---- Installation will serve: Residence e Apartment House ❑ Commercial ❑ Trailer Court pMotel E] Oth`er E] t Number of living units: ---�__ Number of bedrooms___ Number of baths --- --- Lot size ___J_75�__X___�l_��_________________ Water Supply: Public system ❑ Community system ❑ Private Depth to-Water Table, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan R---' , Previous Application Made: (If yes,date.................. .I Noe New Construction: Yes &-No ❑ FHA/VA: Yes e No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _=„„� [No septic tank or cesspool permitted if public sewer-is available within 200 feet.] Septic k: Distance from nearest well-_ .--Distance from foundation-----1p______Mate�aL_ 0 ----------- No. of compartments------ - _Size---7"A"1P>__X__S___Liquid depth--- ��-----Capacity___— . Disposal Field: Distance from nearest well. _.__._Distance from foundation------10......:Distance.to nearest lot Number of lines--------- --------------------�L gth of each }ne--___- __�� ,---- _ _ --Width of�trench_--__��._ ____ . V, Type of filter material'_ Q. '�-._Depth of filter material-_--/-- ---------- Total length Seepage ?. Pit: ► ' Distance to nearest well---_f�G�____Distance from foundation____/a7___-. Dastann6ee to nearesf"Iot Mie.__ Linin material_ �.�X__..5ize: Diameter _�5:- p ' 4 --------------- Numberj of pits._----l�.. .-.. g De to ..s Cesspool Distance from nearest well--------------_Distance from foundation----------I---------Lining material__.___ ------------------- El O Size: Diameter------- ------------------------------Deth------------------------------------------- --------Liquid Ca acit --._gaI0 -. Privy: Distance from nearest well------ --_-___._ . Distance from nearest building.__._. _ _ _•- ______..._ ❑ Distance to nearest lot lire.................�`T --------------i C A-- l ” > , s° r Remodeling and/or repairing (describe):--------------------- -----------------------•----------------- -----------------------' •----;r r i Il x --- --------------------- ------------------------------------------------------------------------------ ------------------------------------------------ ------- ------------------------------------ I hereby certify that I have prepared this,application and that,the,work will be.done in accordance with Sari Joaquin County' ordinances, State laws; and rules and regulations of the San Joaquin Local Health District. 1 [Signed = ---------- --- ------------[Owner ad/or Contractor] [Plot -.13y::.... By::---= — - — _ ,- _ . s Ian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY R-. - APPLICATION ACCEPTED BY------ l� �_-,----- ------------ ------------------------------------------ DATE- ��_'~_� � � . f ` REVIEWEDBY--------------------------------------------- ------------------------- -------------------------------------------- -------- DATE---------- - ------------------------- BUILDING PERMIT ISSUED---------------- ----------------------------------------------------------------- ---- DA•TE--- ------� --- -- ---- ----------- - Altera+ions and/or recommendations ------ e.- --------� ------.. = � •' ------- ---------------------------------------------- =--• •------•--•------- ---------------------I------------ - ----- . Y - ----- ---------------------------------------------- - ---------------------------------------------------------------------------------------- = - --- ----------- ----------=------------------------------------- I -------- ------------------------------------ -- - --------------------- - - f / FINAL INSPEG�lQt�Ba'. < -F �' - , Date_ ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601'E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th!&et' Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.