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FOR Of FICE USE: _^f_ <br /> --- �i--4VZ <br /> .� <br /> 0 APPLICATION FOR SANITATION PERMIT Permit No. .. - 5� <br /> IM. (Complete in Duplicate) <br /> ------------------------- --- --------- <br /> `��' - This Permit Expires 1 Year From Date Issued <br /> Date Issued ...` :.'......... <br /> Application is hereby made'l!-�to the San Joaquin Local;H6al#h-District,�for,,,i�_permif to construct and install the work herein described. <br /> This application is made 'n tom lielylee with County Ordin nee No. 549. 1 <br /> ,. ?13 <br /> JOB ADDRESS AND CATI ._.s S /._. L........ <br /> .. - 1 --'•' I: <br /> ,r <br /> Owner's Name-- l�/ -----------•--- ---• F ?, --------------- Phone.---- <br /> Address • I -------------- 'I� -----------•----••--------- <br /> �! <br /> Contractor's NameSII...._ ---. •----------------------------•------- � Phone_..I�...._- <br /> ---- •--------------------••---•---•- �. <br /> Installation will serve: Residence 29"Ipartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 <br /> i Number of living units. .-/-- Number of bedrooms Nu?nber of. baths I--- Lot size =2 <br /> { Water Supply: Public syst �rrl ❑ Community system[] PrivateW-13epA o Water Table A9 ft € <br /> Vlj <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [E] Adob��ardpan C1 .v <br /> Previous Application Made:1l,(if yes,date___________________ ) No New Construction: Yes [y"No C] FHA/VA:N YesZ;J�o ❑ '`� <br /> TYPE OF INSTALLATION IAND SPECIFICATIONS 4, <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I� ,,fi�rr / <br /> Septic Task: Distance- from nearest weil____!_ '____Distance from foundation---A9----------Matp:pal.__ ZOO? <br /> of compartments-------�--------�.-_ . <br /> .� _ Liquid depth----- _�----------Capalcity.. ��-_-__ <br /> Y` <br /> Disposal Feld: Distance from neareg wel!___D_�------Disfance fromfound`atian_t/de---------Distance to nearesttlot line__��,1..._-..... <br /> Number of lines------- - . Length of each line___. , ..--- //_------Width of trench...r�,_____--- ---------------------- <br /> Depth <br /> ----------........ <br /> Type afifil#er material ., Depth of filter material __� ______�_Total length____, _________________f____ <br /> 1 �� <br /> Seepage Pit: Distance Ito nearest well--- - gm n._..�ra_______--DistNce to nearesf!j-1 I ne._,d�- <br /> x / !�9 ,�- -------- <br /> a <br /> •--... <br /> lumber��of pits____A__--_______'Lining material--- <br /> fr fa dat€b Diamefer_,�,? <br /> size; Depth--ice•------------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundat�_---_----._____.__-.Lining material........ <br /> +I ----------•----•------------ <br /> ❑ S€ze. Diameter-------------------------------------Depth------------------- - ----------------._Liquid Capacity--- �--------••---------gals. <br /> Privy: Distanc)from nearest well _____________-----------------------------------Distance from nearest buildin ' <br /> ❑ Distance'to nearest lot 1€n -- --------•------•------=----•------------•--------------------------- <br /> 1 I <br /> Remodeling and/or repairiri (describe):-- <br /> � I � -------------•-------------•- - <br /> -I ---------- -•------------•-----------------•---•----------•---------------------------- <br /> -------------------•-------- --------•--- -----------------------................1_--•------------------------------------------------------------------------� 1r <br /> -------------------------- <br /> -------------------------- ----------••------------�---------.------------------- <br /> I hereby certify that I Nave prepared4is application and that the work will be done in accordance with Sanl:Joaquin County <br /> ordinances, State laws, and 'rul and regulations of the San Joaquin Local Health District, l <br /> (Signed)-----------------•---- i <br /> By:--------------------------------------------------------- - J-------• e' ntract <br /> . � "L`/ <br /> (rtl �-------j---- ---` <br /> (Plot plan, showing size of lol, location of 'system in r ion to wells, buildings, etc., can be placed on reverse sid�]. <br /> FOR DEPARTME T. E­ONLY <br /> APPLICATION ACCEPTED gY -- - ------ ----- ------- -- -•---- ---------------••------..._ DATE = <br /> REVIEWED BY------------ =IC' <br /> -------•----- DATE----- --------------------------IM <br /> BUILDING PERMIT <br /> �- ISSUED.1--- ----•-----------------------••--------------------------------------------------- DfTE. 11 <br /> -----------•----�(t. atio s of or recommendations:------------------------------------ �IM <br /> ------------------------------------------------------•--------•-•----•----•--1 ..._ <br /> w i M-il�..-. <br /> •----------------------- <br /> ------------------------------------------------ <br /> ------------------ <br /> ._. ._......--.... ....... -------------- <br /> .------••--•----•----------------------------------------------------------------------------------------------------------------- <br /> I. <br /> II ••-------------------•--- <br /> FINAL INSPECTION BY:_ .---- ------ --•--------------- Date------ ..-_ — <br /> G <br /> € SAN JOAQU.IN LOCAL HEALTH DISTRICT` <br /> 130 South American Street SZ300.1N it=C{ak Sr�ei ,) �1 x4lycemore Stre of 4 205 Wect,4ih Street <br /> Stockton,California LodI,'�Callfornla Manteca,California Tracy,C hlifornia <br /> i� jjj <br /> $5 9 REVISED 8.59 2M 5.62 ATLAS <br />