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FOR OFFIC USE: _--_--- ------ �/ _ , — ,APPLICATION -FOR SANITATION PERMIT Permit No. ------------rI ----------------------- (Complete in Dtfplicate) V?:A;I Date Issued ._._.. `z _________________________ ------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin,L-ocal'HeaRh,Dist-rict for a:permit to construct and install the work herein described.This application is made in compliance with County Ordinance No. 549. 4 �I I JOB ADDRESS AND LOCAT]ON.. 50 --------------------•---------------............................. ------•-------•-. . --`. Owner's Name----• - ,C r--------------•-----•---------•-------------- ---------------- Phone................•------ Address....... ._ t 22Contractor's Name...----- ` .._.-....-•----------------------------------------------- -- Phone................................... j Installation will serve: Reside ce'.®"Apartmeni•,.House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] �'oomsusNumber of living units:}'�-- Number;of be -_ Number of baths .I___ Lot size .�t�'_�_l+ ��................................./ 1I Water Supply: Public system:'�Community system ❑ Private ❑ Depth to Water Table _4 4._�t. Character of soil to a depth of 3.feet: 5a nd ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E ardpan ❑ Previous Application Made: {I,f yes,date----,------ -'} No g?'–New Construction: Yes ❑ No Z��FHAYVA: Yes ❑ No 9�- 71 :F TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permittee! if public sewer is available within 200 feet.] #w;� Septic Tank: Distance from nearest well-----=------Distance from found�ation.._./Z-------Material.__ ............. No. of compartments_?__3_A--------------Size---, 1 - O__.__.Liquid depth__ --- ___-------Capacity...S�-a._...._ Disposal Field: Distance from nearest well._�______ Distance from foundati le-____.___.Distance to nearest lot line._.1f......... (� Number of lines......�.S� Length of each line- -__`_______________Width of trench__ `4 - _......_..... ,� f �,q -t ...is 1-------------- Type of filter material.a� ___..-Depth of filter material -------------Total iength.___�.�..._=.._ti:_ . . k k ''-"; i Seepage Pit: Distance•to nearest well--__-rte_-______-Distance from foundation--/ --__..Distance to nearest lot line__�.�......... 6 Number of 'ptis5. �j 1 ®/ : --•--,1'.._..._---Lining material--- � _51ze: Diameter- -------------Depth_.r2 _.b____'-.--/-k ---------. Cesspool: Distance horn nearest well-----------------Distance from foundation....................Lining material___________________...._��........... ..-r-.� -..-ter...w...��,�..r�..F Size: Diarieter-',''-----------_- - - -------------De th_______________________---__ ---Liquid Capacity............................gals. Privy: Distance frorn,.n�earest well--------------------_----------------------------Distance from nearest building.______.____.__------------..____..____._. ❑ Distance to nearest lot line------------------------------ -••------------- ----------------------•--•----------- ...---------------- I Remodeling and/or repairing (descrl(,e}: --- ---- ------------//f_ T '.. i. ...... . ............... ------------ ---------••-------•----- ....... ------------------•-------------------------------------- p I ----------------------------------- --------------------------------------------------------------------------------------------------•------------------ ------.-------------------------------------- 1 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 regulations of the San Joaquin Local Health District. k (Signed)--------------------- ---------- - ---- ! -----------------------------------(CNmm=w=Ip6r Contractor) (Plot plan, showing size of lot, locatto of system to ion t o e Is, buildings,�etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY____. _ I ----r------y ----- ----- - --- ---- - -------------------------- DATE-'-- --g----'----Z-7---'----4 ---Z------- REVIEWEDBY---------------------------------------------------- -- -------• ------------------------------------------------------------ DATE-•-•----••----------•--------------------------------------- BUILDINGPERMIT ISSUED--------------------------- ---------------------------------------------------------------------- DATE--------••--------------------------------------------------- r Alterations and/or recommendaf ns_______________________ ----------- ----------- ____ ---- - • -- •. -- • -- ---- .. . --�--- - --- -------yam" - - ----�---��- ---�-------------------...--------•----------------------- -- -- FINAL INSPECTION BY:----- -.--...._ ------------------- Date------1._91. — CC -b-, SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street `r,,j 24 Syc M9to Srwtr r� 205 West 9th Street v Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-99 9M 6-61 ATLAS