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FOR OFFICE USE: E _-----.--- APPLICATION FOR SANITATION PERMIT Permit No. .. - -------------------------------------------------------0 (Complete in Duplicate) .i Date Issued ---------------____________________----_._� This Permit E-xpires 1 Year From Date Issued 3oi 7 Application is herel3`y made to th"e S-aa=n Joaquin Lgcal�Healfh District forfa ermit to cons an install the work herein described. This application is made in compliance with County Ordinalo 59. --opt �C�}CD1 J08 ADDRESS AND LOCATION _ ACI_ _ _ .__- --- -• - .- --- - --- X Owner Name-------'-----�_��__---?------ -...-- .�,,__L-��-�-----�-`----��----�--------- - one s ............. - .. Address �0 `f-- P..........i •-----_--------------------• ... } Contractor's Name! 1Q1AP&�- -----.TD-1_i .C3-- ' 1�1C ------------------------------------- ...... .. Phone----------------.................. Installation will serve: Residence W--Apartment House ❑ Commercial ❑ Trailer Court [3„ 0tel ❑ Other ❑ Number of livingunits: __ _ _ Number of bedrooms .� _ Number o baths. /'_ �sLo#size ---�.- ................... Water Supply: Public system€❑ Community system ❑ Private �epth r! Water Table 7S_ ft. Character of soil to a depth of 3 feet: Sand. Gravel ❑ Sad Loam ❑ lay Loam ❑ Clay❑ Adob ❑ Hardpan ❑ P Y 14," !Auui � Previous Application Made: [if yes date_--__.-_ .. } No, New Construction: Yes �No�❑ , N : Yes ❑ No,�� --_ T----• - _-Sk-....vim_. __ — �. � -4._ . ...,..,:_ - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Dist$ace- from nearest welL___ �_ Distance from foundation--------------------Material----------------_•_._______.................... a ----- x .)lel No. f Compartments--- •------Size---._-_--_- ----------------Liquid depth--------------- ----------Capacity-------•-----�� l � Y 'Disposal Field: ;a_od .*firom#nea-rest well:- .�J______Distance from,foundatidn..../D_.._...Distance to neares lot line....FA . � !� I 9 11A� # o r ----- Width of trench t ........ � umber o rr YP l lines -- .- P �, 0...--- Total len th_.. ....Avo, ------ Type o: filter matenal._._Yl_-_ _ __--Den th offfilte h material __., _ e tCe ij a �� o nearest well______��-----_Distance from foundation---- .. ..........D��ce to nearest I t line....._+__-------- m ______. � . Number of pits------ ------------Lining material-- Q 1 ----Size: Diameter- _-_- ------____--Depth_ ------------------------- 0 --------------------.-_�. Seepage P' is#an t 440 Cesspool: Distance from nearest well-----'-----------Distance from foundation__------------------Lining material-----------------►t ............ ❑ Size: Diameter-------------------------#-----------Depth--------------- ------------------------------------Liquid Capacity..__--------------------gals. Privy: Distance from nearest well ___I _ _ _ .__ _--.- ________________ ____-________Distance from nearest building----------------------------------------- Distance . ❑ o nearest lot line__J--------------------------------------- ---------•----------------------------------------------•--------------------------------•- Remodelingand/or repairing;,(describe)---------- ---- -------------------------- --------------------------•--------••••-•--•---•-----------•-------------------------------------.....- s .a ---------•----------------------------------------•----------•-----------------------------------------------•-----------------------------------------------------------------------•---------------------------- ---- --------- •••----- --------------•- -------- -------- -... 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 regulationsil of the San Joaquin Local Health District. m-.(Signed)---• ----------- r �� !-�� --- ------=--------------= -_�_ :::_-----------=-----._:.:., -= _(Owner-and/or-Contractor)= � By: ----------------•--•------••-------------------------------`----------------------•------_-------------------(Title)---------------------------------------.----- - ---- --------- � (Plot plan, showing size of lot, location of systemtin relation to wells, buildings, etc., can be placed on reverse side). E tFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------1---r - '' ---- ----I--------------------------------------------------- DATE---------�-74.7--45-a---------•----- I tREVIEWED BY--------_----------_1 ---- ------------- ----------•-I--------------------------------------------------- DATE------•-----------------------------•-- -- _ BUILDING PERMIT ISSUED-------------------------------------- .......-----•�---------------------------------------------- DATE Alterations and/or recommendations: --------------`-----------------------------------------------------------------------------I..----•-•...---•-•---------- ------ i i FINAL SPEC R Dat� ....----- ---•------------ te -- _._...._. ' ` r Ir SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street i� 300 Wert Oak Street 124 Sycamore Street 205 Wert 9th Street Stockton,California IE Lodi,California Manteca,California Tracy,California II -_ ES 9 REVISED 8.59 2M 5-62 ATLAS i