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FOR OFFI E SE: - -- - - ----- ---- moi"7 ��_- ___.�__ f �- Per APPLICATIO - N FOR SANITATION PERMIT --------------- _____________________""""-- (Complete in Duplicate) Date Issued ..... This Permit Expires 1 Year From Date Issued ----- 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. i JOB ADDRESS AND LOCATION-- ---7-�--�---•--- .. � ------�`•....=. -------•-•----- _ -. ..........t -- {� --------- Phone.}�U: 2-033 i Owner's Name.--- n.k4 X.s.lu4--------L-tI. LS ---•-••-------•-------•--------- ---------- Address------- ------------- ------- ----tea '---------------------- IContractor's Name...... --------------------------------------------------------------------------------------------------------------------- Phone--------------------------•------ Installation will serve: Residence IVApartment House [ICommercial ❑ Trailer Court [3Motel ❑ Other [I 1 Number of living units. L_ Number of bedrooms .�___ Number of baths :�4m- Lot size -_-••---•----- Water Supply: Public system & Community system Cl Private ❑ Dept ro_WeterJable--)_ ft. peon M Character of soil to a'depth of 3 feet: Sand ❑ Gravel El Sandy Loam 0 Clay Loam ElClay ❑ Adobe® Hardpan ❑ Previous Application Made- .(if yes;date---------.----------I No ®, New Construction: Yes ®, No ❑ FHA/VA: Yes E, No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well__I'1Q�1_S�..Distance from foundation ..__._.._.Material__r.�C1__kj__0_S�-9__--"""••-• ----•-- ,� k Z_ 4' ` - q 'd depth 4-" -------- • Capacity -------•-- No. of compartments------------------------ X-��1--X-- -.---Li ui , __Distance from foundation -----------Distance to nearest lot line.i�---------- 3- -----.- Disposal Field: Distance from nearest well-l�Ai►5� �L Number of IInes____, -------------------J------Len Length of each line..9.-_IlcL'-----U-140--Width of trench-"___.z. ------------ ----- Number of,filter-ma.terial,� .._r .�.�-"_,Depth of_filter material._____-l_gS_`_'.___._Total,Jength_.___ Z__ Q°-.•-------•---------- :: " Seepage Pit: Distance to nearest well.......... ..--------- Distance from foundation--------............Distance to nearest lot line--"_...____..___. _Lining- mater.ial---------_------.;_Size: Dia meter-- "---_ Depth_._..:.:_...-................... ❑ Number of pits-:•---------------- - J ` .J Y 1 Cesspool: Distance from nearest well-----------------Distance from foundation__"---------------lei Lining ma eachCapgals. Size: Diameter----------------------- ------Depth---•-----------="-----•-------- -------------------- 4 , ,. Privy: Distance from nearest well-__.--"_:7__.•__"--____"".____"_"__-""..-__-- Distance`-from'ri arest'buildin ❑ y -----•-•---_----------- Distance to nearest lot line------------------------------------- --------•y-.----•------•---------.....------•- ------ Remodeling and/or repairing (describe):.___-- _i_n ---"------••----------------••------------------•:----------------•----------------------•-- ------------------------• --� - -- ---------------------- ----------------------------------------•--------------------•------------•----•------------ ....-----------------------••------------•----- 1 hereby certify that I have prepared this application and that the work will be done in ac ord'ance_wi+h San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. ? - .-- / (Owner and/or Contractor] (Signed)_ --------•------------------- ----------------------- ---------------------........r------------------ - -- By:- -- ----- ------•------- (r+le] - (Plot plan, showing size of lot, cation of system in relation +o wells, buildings, etc., can be placed on reverse side]. FCR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---------- ---------------------------------------_:7� -DATE---4'Lam' ------------------------------ _ DATE------------------------------------------------------------- REVIEWEDBY---------------------------------------------------------------- ---- -------------------------------.... BUILDING PERMIT ISSUED--------------------------------------------- ------------ -----------• DATE:----------- ------------------------------- ------- I ��.t.[a •ku� ... Alterations and/or recommend'a+ions:_�.__�_-_�-�------•--------t-��-f=��'-`-�-'�----=`••""-- �•�•"-""-� ............................- -------------•--------• ------------------------------- ------------------------•--- ......... ------ ----- ------ FINAL INSPECTION BY:..___..Q..<-� �---------- --------- --------- Date------ ----------•----•- --------------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerlcan'Street 300 West oak Srreet 144'Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EVISED 8-59„21AA 5.62 ATLAS ' ,...