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v - .-- W. L.: _ __- -...- ___ --.. APPLICATION FOR SANITATION PERMIT Permit No. _�_.3.�-� ._ ---------I -- (Complete in Duplicate) =11This Permit Ex fres I Year From Date Issued r, - - Date Issued .-L.-[ Application is hereby made'to the San Joaquin Local Health District for a pe it to construct and install the work herein described. This application is mad in cop�Iipnce with County Ordinance No. 549. -Go�Si—;�o.SP"-•;��. ! JOB ADDRESS AND LO ATIO I ... - �� __-- --_-••1- 9--�:_ _/�� Owner's Name-----..... --- Address.............................--- ----------------- one------------------------------------ r .a_.1l_Lf. ' Contractor's Name-------_... ---_--------------------*---------------------------------------------------------------- • -----------------•--------•-------•-------•---------...---------•----------•---------- Phone Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of livingunitslc J----/-_ Number of bedrooms _,3_.- Number of baths __2__ Lot size .1b 1 �!_..-,_3 Water Supply: Public syste h. ❑ Community system ..._ tY Y ❑ Private ®Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ ClayLoa Previous Application Made: (If yes date.__-- - m �rClaY E:1 Adobe[I Hardpan ❑ ----) No 2'_New Construction: Yes ®'No ❑ FHANA: Yes ❑ No ❑— TYPE OF INSTALLATION AND SPECIFICATIONS: . (No.septic tank or cesspool_permittedif-public sewer_is available within 200 fee}.] i; + is available_la Iter Septic Tank: Distance from nearest well_0.1-----------Distance from foundation_fd_-.____-__ - No. of compartments_.__2---------------•--Size_----•- -x Material--------- -------•-- __.... -----Liquid daplh__..__.zr'_�-___--_-----Capacity---.$from nearest welLcj-Q--`.._._.Distance from foundation._ra. ---Distance to nearest lot line........... Disposal Field: NumberDistanceaf lines------•-----`L__.___•-----------Length of eachline---•--��_�•------------ y �1 --Width of trench.---• ---------------------_- 6, Type of fiter material_.1 -6-t------- of filter material.... length____________ _ ---•__--_----_-_ See Pit: Distancef6er nearest well___400---- p g Distance froom�,n foundation_._?_�7__--__-,Distance to nearest lot line._t?_=_.-1_---- f Pits------- material.--. ,15 --$ize: -------- F� d ------------Depth_--------z'��'------------- Cesspool: rom nearest well-----------------Distance from foundation-----------____.__. Lining material__________ ___ ❑ Size'.Distance D emeter-------------------------•- ......................... Distance f, Depth. ------------------------------Li Liquid Capacity Priv i q --•-•--•----•----•----•-•-•-9als. from nearest well______________-----------------------------------Distance from nearest building ❑ Distance to nearest lot line 9 --•-----•---•--- -•---- -- ------------------------------------ Remodeling and/or-repairing (describe)___________________ --•-----•----------------------------••-•-•-•---•- ..... ----•----------•-•-----•--------•--------------- - ------•---------------------------• lI -------•---------••----------------••----------- -- ----------•----------• I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and gul ions of the San Joaquin Local Health District. (Signed)............. �I •- ... •-------------------•---------------- ----------(Owner and/or Contractor) w---ABY.-------••------------------------------ (Plot plan, showing . ite)....size of lotlocation of system in relation to wells, buildings, etc., 'can- -be placed on reverse side]. , FOR DEPARTMENT LI5E ONLY APPLICATION ACCEPTED BY'!---------------------------- REVIEWED BY 11 --------------------------------------------- C� ---- DATE,----------•----7'f----`. .� -- -- ------- DATE_.-----•----•------------- -- BUILDING PERMIT ISSUED------��----•---------•------------ - --------- --------- ----------- -------•--------•-- ------------------- --------------- DATE.------_--------•------- Aiteratians and/or recommend'ations------------------ -------- - -••--------•-- •.................................. ------------ --------- ----------•--- ----..-_---------•----------•----•--•-----------••------•--------•---- -------••-------------- ••-------..._ iI ---------............11 ------------------------•----- FINAL INSPECTION BY:........ .._._ ------ ------ ---- Date - _ SAN JOAQUIAIOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Strut 205 West 9th Street Stockton,California I Lodi,California E$ 9 REVISED $-99 YM y-61 ATLAS Montego,California Tracy,California