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FOR OFFICE SE: CL / I�IG --- /U d Permit No ��P - - 14 -- ------ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate)This Permit Expires 1 Year From Data Issued Hy/ _ H Date Issued ----------1-----:-•. - ----------------------------------�.._-___-______-.__._._ 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. 549. JOB ADDRESS AND FCATIO,, N------ ---- --•- �--'•'------------------ ------------•----._..... W . z �-�Cy Owner's Name------- L.G'- ��- lS -= = Phone-•-- ---------_---------- ---------- Address.........•••----------- ------ ` ----------------•-----------...--••------------------••--------•-•--------•-------- Contractor's Name...--------•-- iI ................................ Phone.................................... Installation will serve: Resideni��e [Apartment House ❑ Commercial ❑ Trailer Court/0 Motel ❑ Other ❑ Number of living units:.-t- .- Number of bedrooms . Number of baths __l-___ Lot size __________________�---_�. ---...... Water Supply: Public system' 'Commuriity system ❑ Private ❑ Depth to Water Table .. _?-. ft- Character of soil to a depth of:3`feet: Sand Gravel ❑ -SandyrLoam"❑\ Clay Loam ❑Clay ❑-'Adobe Hardpan ❑ �I I No FHA/VA: Yes ❑ No Previous Application Made: (If yes,date_ . _r_ ) N ❑ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICA IONS: N septic tank or cesspool permitted if public sewer is available within 240 feet.) C Septic Tank: Distance from nearest well____�;.._____r'Uistance from �r"d ion .__ �.__------ p No. of compartments_._---Size__. - °-_:-L aid d'ep. ---_-t ' -��acity___- .: ❑ n, ---� I �ted- Distance from nearest well_... .____.Distance from foundation___.. tance to nearest lot line...::_:..:.;. ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french---•_------•--------_---...--- ` 06 Type of filter material------- of filter material_._.. `_� Total length.._..____••-----...---•-------,. � x. S epage Pit: Distance to nearest well______ ____________Distance m fou fton-----...............Dinc�a�to nearest lot line....- l� umber of pits----------4-----------Lining material__ O .• '_ �1Size: Diameter__ --•--•----...Depth----..- -------------- �. Cesspool: D Lance from nearest well-----------------Distance from foundation-_.__-..____-.- Lining material------------------------------------- ElS : Diameter--------------------------------------Depth_ •-------------------------------- -------------!Liquid Capacity------------- --------------gals. Privy: Distance from nearest well------------- d z- Distfrom nearest building------------------------------------------------- ance .. 9--------------••------------------------------------------ Distance ❑ h to nearest lot line-------------------•---------------- .. ------...r-------••----- ...-----•...•-•--....---------••------...- - ----- r ` Remodeling and/or repairing) (describe):--------------------------------------------------------------.------------------------------------i----*--------------------------------------------------------- •--•--•-------------------------------------------------------•- 0 ---------------•-•------------------------------1—------•-------------------------------------------'•-• ----------------------------------------...------------------------------------------------------------------- I hereby certify that I have prepared this application and,that the work will be done in accordance with San Joaquin County ordinances, tate laws, and?riles and regulations of the San Joaquin Local Health District.T (Signed) .. ,w F --3..:_-----`----`-�---------------------(Owner and/or Contractor) --• -- ---------------•--------=------•---------------------'------------ �; i By---------------------- .. Title - (Piot plan. showing size of lot; location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY "' TE " t ----1/ APPLICATION ACCEPTED BY__________________.___-___ -. REVIEWED BY.-• �� -------------- DATE UILDIN and/or omm ;�1-------------- ------------•-•-------------•--------------------••------------------------------- DA --------------•- f BUILDING PER;IT ISSUED.adations. �._ .. - --- ---•------ --------------- e-------- - /� r - - -- --- - -- - I. ----------- ----- I -•-.•----------------------------------------•--- { Date-----i---��-----r= 7. ...Co.-�---------------------- FINAL INSPECTION BY::,! i -___,. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Ee 9 REVISEn 6.69 RM 6'61 ATLAS