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FOR OFFICE USE: --------------------------------------------------------- - ----------------------.--------------.___.____..________- APPLICATION FOR SANITATION PERMIT Permit No. /.04_2 ---------- ----------------------------------•----------- (Complete in Duplicate) 7� (o This Permit Expires 1 Year From Date Issued 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. �.��} Cir 2--`f0-•,33 � g-p ra .67. 11-(t G..�c�],a. �-g� f,� �p y� 9 JOB ADDRESS AND LOCA I N l -- �A-�� -1'e�� 'G L_e.�-Lp',x s... AW Owner's Name----------- f.r- •-----...... ,t --�-J--- f� -------- ---------_---•-----=: Phone.... r Address---------------------S+6.0......... r 1 =4 H.w:- Contractor's Name----- ---------- RQ oia Zaal--e-'r------------------------------------------ t . ..... Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial j— ��f iKR Tr-a ile( Co..1� Mol [3 ether [3Number of living units: ________ Number of bedrooms __ . Number of baths ______,_ Lot size _l05W/,P s-_. _1d X-_-TSf" Water Supply: Public system Community system ❑ Private ❑ Depth4 Water;Table __'______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam. Clay Lo m El- Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank:'`, i Distance from nearest well-_______________Distance from foundation.__-.-- :._...,___Material;___________________---_-..._-_ T � No. of compartments----------- -------Size--------------------------------Liquid depth-..-------------- --------Capacity---( - e�? v [�y Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line................. Y � f ( 19 Number of lines-----------------------------------Length of each line--------------------_------.Width of trench--------.--------------/ Type of filter material------------_____--------Depth of filter material____..._.___________._Total length______.____-_ --_.-_.._...__ Seepage it: Distance to nearest ell----------------------Distance from foundation------------........Distance to nearest lot line-------._........ I l Number of pits...... .---------Lining material-----------------------Size: Diameter-----------............Depth------- -------- ----------- Cesspool: Distance from nearest well_________________Distance from foundation----------- Lining material------------------------------------- f0 ❑ PO Size: Diameter--------------------------------------Depth----------•---------------- ------------=- ----Liquid Capacity-----------------------•--•-gals, Privy: Distance from nearest well-------------------------------------------------Distance,from nearest building__________---_----_---_--_-_________-____. ❑ Distance to nearest lot line----------------------------------------------------------------------- -•----------------------•-------•------•-- -------•-----•-------------------------------------------------------- T --•------•-••--------------------------------------- � --- Remodeling and/or repairing (describe):____--/ne1! r--- � I 'a'-- -'-�-j"-- _-_-- ---------=---------•--.....----•- - X01.. ---:c.�]. o I hereby certify that I have prepareAis application and that the work will be•done inaccorRance with Sen oaquin County ordinances, State laws, and rules and regulations of the!San Joaquin Cocai_'F'lealfh_DWr_ic+ y� (Signed).... Y`' �I �d � lt ------- L =-•------ ------(Owner and/o� Contractor) BY:...................... -------= = =--•----(Tiiitle)--••-•-`•------------------------ :-__ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------------------------ REDATE _. .. ---------- REVIEWED BY------------------- -------•------------••-----------------------------------------------------------•--•-••_ ------- DATE------------------------------------------------------------ BUILDING PERMIT 155UEQ. ----------------------- ------------------------------- DATE-----------------------.--•----------------------- Alterations and/or recommendations: • --------------------------------------==------_------_---..--------_-........................................ -------------------------------------------------------------------- -------------------------------------------------------------------•-----------.-------•--------..-•------------•------------------•---•---------------- ------------------------•-•.._.....•-•-•--••--•-------•---------------------------------------------- --------- --------------•------------...----------------------------------------------•-•-•----------------------------- ------------------------------------------------------•-'_ ------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------- ...................... - --------------------------------------------------- -.._..------------------------------------------- FINAL -- ..-..FINAL fNSPECTION BY: -- -- •-----__-- --�.- -- -----•---------------- Date._-d_�_ ��-- V-------- •- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-61 ATLAS