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-------------------- FOR OFFICE USE: it No. ....... 1P/Z _��T —------ - Perm 51_(e APPLICATION FOR SANITATION PERMIT ------------------------- -------------------------- 4? -------------- (Complete in Duplicatel Date issued ....................... -- -------- - This Permit Ex aires I Year From Date Issued ------------------------ ----- -------------- Application is hereby made to the Son Joaquin Local Healfh District for a permit to construct and install the work herein described. This arplication,is rnade1ncompliance:with County Ordinance No. 549. y ...................... ----------•...........I....... JOB ADDRESS AND LOCATION._- Owner's Name----- ------ ---------------------------------------------------------- ....... Phone-----------•-------•................ Address--- ------a-----t - P _V ---- - Phone----------------------------------- Contractor's Name-------tg>-------- L e%66R Trailer C�urt [] Motel [3 Other OC tA r,\p - - Installation will serve: Residence ❑ Apartment House []—CZ-mrK_e_rciaI ......11 ..... bedrooms 2 'R'belr of Lot size -------------------------------------------- •- Number of living units: -------- Number of L um GM P Table ---8-- ft. iRT Water Supply: Public system El Community systl ri�'ate:&I, Depth to Water Ta Gravel E]-�Sandy_L6amn Clay Loam [:] Clay [3 Aclobeo Hardpan [] Character of soil to a depth of 3 feet: Sanclb k o Ej FHA/VA, Yes ❑ No 29 Previous Application Made: (if yes,date------------------4_1 Na [D' ., N I ew.I Cons t4cfl-on: Yes S N TYPE OF INSTALLATION AND SPECIFICATIONS;, permitti4___jf public sewer is available within 200 feet.17., (No septic tank or cesspool �ql — '> - I I I � OV -_Diffg—nce fF0_Mfoundation_'1JC)--------- Distance from nearest -N-C Septic Tank: depth_.........A. ------------Capacity.-in, _0J; 2- j ... ......... Liquid No.-of..compartments---------------------- 91 1 1 1 1 .......Distance to nearest lot line...._"------------ Distance from nearest well_ froFn foundition Disposal Field: -------Length of-eac.h line_.---_. of trench.--_---Z_�_ ------- Number of Imes_.._----------------- h of filter material-! _-Total length---- Type of filter er I ...Distance to nearest lot line----------------- r-1-i----Distance from,foundatic'n.........I-------- Seepage Pit' Distance to nearest well.............;= I I -F -- 1 ------------ f. Size: Diameter----- -------------Depth------------------ ❑ Number of pits--------- ma On ---------- Cesspool: Distance from nearest well Ic 1 0 from',foundation------- ------- ---Lining material--------------------- �:�7::'Dista-r- 'N 1 "1*7 --------------------------------Liquid Capacity-------------------------- Fj Size: Diameter------------------------------- Dep*-�............. 4 1 ------------------- Distance from nearest well-___.__________________ Distance from nearest building----------------------- Privy: -------�_t--r"T - --------------------------------------------------------------- 0 Distance to nearest lot line----------------------- ---------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------------------- ----------------t ��-- ------------------------------------------------------------------- ............---------------------------------- -------I---------I---------------------------------------------------- , ----------- ----------------- ----I--- ----------------------------------1.-------------------- ------------------11----------------------------------------I--------------------------- I 1 5 - ---------------- -------------------------- - ----------------------.............-----------WV6--------- -------------------------------------------------- ----------- ---------- --------- ---------I_.hereby-_certify-_that-a-tI-_have..prepared- . this application arid that tW_wori_will�bei done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San}Joaquin Local'Health Dist;ict. :F I - Contractor) ---------(Owner and/or Contractor) --------_----- -------------------------- ----------------- (Signed)... --------------------------- -------- r I . I i By:._.... - Me) .... ........ . ----------- -------- ----------(Ti ------------------------------------ ................................... ------------------------------------------- ------- --------------S, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in relation to wells, building FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -------------------------------------------------------- ---------DATE-- ---------------------------- REVIEWEDBY.--------------------------------------------- ------------------------------------------------------------------------------ DATE------------._....----------------------I--_-------- BUILDINGPERMIT ISSUED----------------------------------------------------------- -------------------- ---------- DATE---------------------I--------------------------------------- . . ........ --------------------- Alteration and/or recommendations:---1_0------- -------- ---04--t.-T - -----J -------- ....... ....... ------------------------------I------------ ---------------------------------- ----------------------------------------- ---- ------------------------------------------------------------------------------------ -------------------------------------------------V_t -------------------------- ------------------------------------------- ------------------ -------------------------------------------------------- ------------- ------------------------ -------------------------------------------------------------------- ----------------------------------- ------------------- ------------- ------------------------------------ FINAL INSPECTION BY:.----0....... ..S ----------------------- Date--- ------------------------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Simet 144 sycamore Street 205 Well 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES Sp RpVlrEn S-59 9M 0-61 ATLAS