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FOR OFFICE USE: ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..4.3........ ......._.......l (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. �}.9�•N(3-r7c�Cl f1�- �e ,fes JOB ADDRESS AND ON _ 9Gd� . ... •••-.� � 1... �`� n ... _. Phone....................... ` ----------- ----------•------------------ ------ --------- --- -Owner's Name Address.-------- .... ----------------------- -•--------- ---.....•---------- ----Contractor's t t I Installation will serve: Residence Apartment House ❑ Commercial'[] Trailer-Court ❑ Motel ❑ Other ❑ f Number of living units. I_ Number ofbedrooms.I-:'Number of-baths -------- Lot size -------------------- ....................................... Water, Su • Publics stem ❑ Communitys stern''.❑� Pri ate �De +h to.Water.Tablet. 1 PPI •YY Y'• Y _ p Character of soil to a depth of 3 feet: Sarid.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date_-----.--.--".-----=) YNo ❑ New ConstruOion:.Yes E] No ❑ �FHA/VA: Yes ❑ No ❑ TYPE SOF INSTALLATION AND SPECIFICATIONS: ^ } (No septic tank or cesspool permitted if public sewer,is available within 200 feet.) Sf ptic Tank: Distance from nearest well___ FV-----Distancefrom foundation.--_-N....---.Material_----- ............. .No. of compartments---------;rn-----------Size.. ;_,X!kX---[.4--------Liquid depth........... capacity.._ 00. ..... Q Disposal Field: Distance from nearest w il."-.-Sa._Distance from fou dation=_-�f?_.:....._-_-Distancejto nearest lot line.:S....�_ Number of lines-- _--._.. -."- Length of each line_.___---�©-_. -----.Width of trench..... _____�................. Type of filter material..... _- - - ._ -Depth of�filter material___--_/_.Z_ -----.Total length__ ----------------------- Seepage Pit: Distance to nearest well--_-------_--.------Distance from foundation....................Distance to nearest lot line................. 0 Nuof pits----------- ------Lining material--------.--------------Size: Diameter------------------------Depth...............__................ , - �Ces pool: N� ,,t-nce\frommber nearest well-----------------Distance from foundation--------------------Lining material..----------------............ -.-_- j �� } i Size: Diameter---------------- --------------------De th--------------------- ----- Liquid Capacity gals. `I [] , 1 p 9 p tY•--•---....-•--------------- r -'Privy:^ Distance,from' ne8rest well--------------------------------•---------------Distance from nearest building------------------------------------------ to Distanceto nearest lot line-------------------------------------------------------------- -----------------------------•---------------------•--------------- T <Remodeling and/or repairing (describe)-------------------------------------------•-•--------------------------•---- t --------------------- ----------------------------- ------..----- ---------------------------------------------- ------------------------------------- I ! r --------------------------------------- 1 I f I I I--!I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ! rordiisances, St411aws, nd rules and guiations of t San Joagd Local Health District,(Signed)---.......- r ------------- -- - ------ ---------------------------------------------------------------{Owner and/or Contractor) 7 �By: °� --- (rtlel _ � .� w[Plot plan,showing size"of lot,"location of system in relation to wells, buildings,'etc.,ca"ri be'placed on'-reverie side)." FOR DEPARTMENT USE ONLY r 4-A•PPMLIQATION ACCEPTE© BY -- - DATE-,--..?-- -� -------------------------------- 'REVIEWED BY-----------------------------------•-------------------------------•--------------------------------------------• -- ;-•------ DATE------------------I---------...-------------------------- BUIL'DING PERMIT ISSUED-------------------------------------------------------------------------------------•--- - _._'bATE!----•------------------------------------------------------ _Wteretions and/or,recommendations------------------ --------------------------------------------------------------------------------•------.....------j---......•---.................--------- R� -- :------------------- = ---------------••--•-------------------•--...---------------------------------------•--------------- -•------------------.._..--------) ---------------------------------••- j i 1 .----------.�-----------------------•---•-------------- ----------------------------._-- � -._-.. ----------- -- - �- FINAL INSPECTION BY:. -------------------- Date----3......Ll -------- -- 6,_�---- . SAN JOAQUIN LOCAL HEALTH.DISTRICT 130 South American Streef 300 West Oak STreef 124 Syco ore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California E$ 9 REVISED 8.59 $M 5-61 ATLAS 4