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I' FOR OFFICE USE: r ----- _ APPLICATION FOR SANITATION PERMIT Permit No. -_-• -... f� `----------------• .------ --- --------------------------- (Complete Duplicate) q� . i+i Date issued ----------------------------------------------------- This Permit Expires 1 Year From Date Issued E 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_ 1..: `__•_g7p �'� j :----.._ h�l`=- i Owner's Name........ -I,------------ ------- •- --•----------- Phone. �`✓�° _� _� �• c Address...............Aw g----------R -----...+! .....---•..........:......................................................... Contractor s Name l e:'lL flzu� �G !.. �7� ------------ . ..--- i Installation'will serve: Residence,® Apartment douse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .......... Number of bedrooms I__-_ Number of baths -_,/--- Lot size '?........._................... I Water Supply: Public system ❑ Community system ❑ Private 2] Depth to'Water Table _114_ ft. Character of soil to a depth of 3 feet: Send Q Gravel ❑ Sandy Loam I@ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan-[] Previous Application Made: {If yes,date----------_--------) No.Z New Construction: Yes ® No ElFHA/VA: Yes ❑ Nom TYPE-91F INSTALLATION AND SPECIFICATIONS: (No septic tan-lc'or casspoal permitted?if pu6lii�we�is��veilable�vit�in-200-feet:} - ' C-d N�G Y-�TP�f •�=-.-��: Septic Tank' Distance from nearest weii____c}.�_---_Distance from foundation_--__I...-�..-..Mat rial__� -`--_C'45�. No. of compartments------- ------------ ..x..-. Liquid-depth____ -Capacity... Disposal Field: Distance from nearest well_`:S _._-_•Distance from foundation___'__--- istance,to nearest I a...r......... '�}.,/ ® . Number of lines_-- --- -_- Length of each line-------- �___---._--- W2 of trench 6 .r"6 - e - --------f- Type of filter material--- --ted--Depth of filter material-----___4J............Total length...... . .. ........ -60 Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest of line------_.-- ❑ Number of pits_-------------------Lining material-----------------------Size: Diameter...................._Depth----.._...------_----- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material------------------------------------- 0 1 Size. Diameter--------------------------------------De th_-:-------------------------------------------------Li Liquid Capacity- �] � � . P q P tY---------------•----........gals. Privy: Distance from nearest well------------------------------------ Distance from nearest building---------::_---------- ❑ � . Dlstanee.to2 Barest lot line-----------•-------------------------------------------------------••-----...-•--•-------•-------------...----------•--•-..._...._ Remodeling and/or repairing (describe)-------------------------------------------------------------------------`-•---------••-•----•---••• ----------------------- ....................... -----------------------------------------------•---•----------•-----------•-----------•----------------------------- --•-------••-------••--••----------------------------------------------------------------------- ............. •--••-----•-•-----------•--- ....................................................•---—----------------•---------•--------------------------------------------------------------•--------- -- •------• ----------- --------- --•-----------------•------.-------.--------------•-•------•------•-•-• ---------------------------• -----------------------------------------------------11 ---- I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rules and regulations of the San Joa in Local Health District. (Signed)......_._ _. {... ......•° -----------------------••------- •-•-----------------(Owner and/or Contractor)4, y• — _ Title..... :--©- P -.-.:.:..,--•-.....- B • .P(l ( 1 (Plot,plen:,.sh Ing e'_af lot, ocation.a,_sys in relation-aorwells _biiildin s,-,tc.,,ccan,be-p#aced-on reverse side).' FOR DEPARTMENT USE ONLY p l APPLICATION ACCEPTED BY--------------------------- --- -----------------------�R•0-1,ej.4f__ DATE------------ 4 ... BY------------------------•--•-------------------------------------------------------------------------- --------------------• DATE-------------•--------------•---------------•------------- BUILDING PERMIT ISSUED----------------------------------------------------- ---------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:......................................................................................................--------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- ............... .................................----------------------------------------------------- . --------------- ------ ----- ------ ----------- -------------------•-----.----------.-.------------------------------=----- - ---- ------- t ------------------------------------ -------- ---- - ------- ------ - --•------ ---- ---- ------ ------- -------`-`•---- -._.----•------------------------------------------------------------------- F1NAL INSPEC BY: [ Date-.../,/) ------------ `-----------=-----•---------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT - 130 South American Street 300 West Oak Slreet 124!Synpmore Striet 205 West 91h Strict Stockton,California Lodi,California Manteca,California Tracy,California tS 9 REVISED 8.69 2M 5-61 ATLAS A