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-r'%-)K v4&rll.t UbL: r. ----------------- 1APPLICATION FOR SANITATION PERMIT Permit No. -- -- --- (Complete in Duplicate) t Otto w j ` �.This Permit Ex fires 1 Year From Date Issued Date Issued y Application is hereby made to the San Joaquin Local Health District for a permit to construct aninstall erthe wok her described. This application is made in yo ' nce with County Ordinance No. 549. JOB ADDRESS AND LOCD� i ° - =-----A _Ar-CZALD--------------- Owner's Name-------- ----�--- --' �--� - -•-- �-�_� �LL - - ------------------------ --------- - --------------------- ------------------ Phone---- ------------------------------- ----------------------- �- � x---------- ------- �__P r - Address------------------------------ --------------------- -- ---- Contractors Name�1��+Q_nl�---�----�Q�l�_._-�--------- ---- • - •------------------ ------ Phone----;;-----..__... Installation will serve: Residence [Apartment House 0 Commercial ❑ Trailer Court ❑n Motej'❑' Otfier ❑ Number of living units: 2-1_-__- Number of bedrooms ��--_ Number of baths '� Lot size _ CRE.)q r --••----- ----------------- Water Supply: Public system ❑ Community system ❑ Private .f Depth to Water Table /.J�_lo, Character of soil to a depth of 3 feet: Sand V * '1 Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay [] Adobe ❑ Hardpan 11Previous Application Made: (If yes,dpte--------- J No 'New Construction: Yes ❑ No ( "FHA/VA: Yes ❑ No 2— TYPE .OF INSTALLATION AND SPECIFICATIONS: (No septic tarik-or cesspool ls&mitted2if'public sewer isi-available,within4200 feet.) _ Septic T k: Distance from n ares 5d____ Distance from founds ion______ _ ' � r �• f�'-------.MateriLj ,zal---.C�-(�1�.1�lI,�L�,-------.. No, of compartments_ __.-_2—:.-.---:$ize,_ _ -k-, •___,_ Liquid depth_-_ �-�,_--.Ca acit ��e__.0 � T �� Distance to nearest lot line i, Q ` �""' lE p Y Number of fines____________ ______ _Distance•-from foundati n '____ Q Disposal Field: Distance from nearest well_ _ IP Type Number filter mat----j 7 ,- -f Ler'thxof each line��_�-_'_�__--.--W,_dth of trench__.__ --- __ - Depth of filter material_ �:�_ � flc3 j V., 44 . ----Total length �0Q--- --- ------ --- See�ge Pit: lD�umabee o{pmts rest well 'Lihin Distance,-From.founda}ion__------------------Distance to nearest lot line------ . � Number �. material" .Size: Diamete`r------------------ ----Depth--------------------------- p I 4d��3 9 � i Cess ool: Distance fi-om nearest well_._._____ __ Ust+ance from 'founda".tion__:.________________Lining material_-.---------------------------------- .1)44 _ - -- ---- --- --- -- -- ❑ Size: Diameter-----I Llr [ Depth --------------------------Liquid Capacity- ------------------------galstA Priv..y'; ' yy i ) Distance from nearest well ____� Fh _______ ___ _____Distance from nearest buiidin g {� ---- •--- - is ante to nearest lot line--------_._ ----------- Remodeling hand/ori,repairing'(describe)_______________. ._ --------•-•------- --------------------------; ------------- Pt Ac Xf `ff^kc---- 5-i. / ------------------- ----------------------------------------- ------ ------------- •---------------------------------------- ---------------'---•-------------------------------•---------------- = -� I hereby rtif that.l have re orad this a hca' . --------------------- - ---------- __ ,. r P pp tion and that the work will be Jone in accordance with San Joaquin County ordinances, S to I ws, an rules a of t regulations of fhe San Joaquin Local Health District. (Signe }- ---- ----- ----- - - - -- �----- --------------- =- /. . ---- --------------- - ---- ------------:<----------- _: ,I (Owner and/or Contractor) .-- � -----(Title}--( 0 or (Piot plan, showing size of lot, location"of system�inTrelation to wells, buildings, etc., can be placed on reverse--side}. T' i! i I `FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEXBY"""`""` R � "".."'m"""A" DATE_ .. 3 REVIEWED I3Y - — •�- ------- ---- r .== �,;G DATE_ -. ------------------------ ................ PERMIT ISSiJED'---- ----------- ------ DATE. - Alterations and/o�recommendations:__t R:'""'�` ------------- i. _ z.--- s --- - ------------- - r -------- - --- -- -------------- -----• FINAL INSPECT N BY- _ -- - -- Date----------- -- yr ~ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Sheet 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,Californip ' r