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OR OFFICE USE:�� APPLICATION FOR SANITATION PERMIT Permit No. .....)c��.:�� Com lete in Duplicate) ( �-- P Date Issued ... .... ..... ---..- --------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to4construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LO N_-,----- �( ------ -- •--••••....•--••._...•• -----••---------------•----- Owner's Name... .- - . •-• .- -•--- Phone Address----- -- - -- ------- --- -------•----•--.4...--•--------•--- -•-•--.....----...... _ p _ Contractor's Name..__ . _-y. .. .-•;-:, Phan -/.y,1�. yylY Installation will serve: Residence -pApart nt House ❑ Commercial ❑ Trailer ICourt ❑ Motel ther ❑ Number of living units: Number of bedrooms,,?--- Number of baths rZ_ Lot size ....,� :..................... Water Supply: Public system ❑ Community system ❑ Private 21-ftpth to Water Table d.�"_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date....................) No [4—''Flew Construction: Yeses FHA/VA: Yes ❑ No [ •---- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pt'c -- Distance from nearest well... Distance ;from foundation._.- - ,.__ ........._.._Ca acNo. of compartments------ ---------------Size.....OV- Liquid de th... itY = eL 4Disposaj .... eld: Distance from nearest well�`—I1_� Distance from foundation./4� ..`_......Distance to nearest lot line.....:..'......... q� ' Number of lines........./--------------- Length of each line...... .Width of trench..........<...................... \1 a- Type of filter material,,aP ? '__-_-_-Depth of filter material------/6-`--___Total length__::_.......:;i�7a.................... Seepage Pit- Distance to nearest well__)'." ............Distance from 0bridation---/zU.. _.Distance to nearest lot line Number of pits......./.............Lining material - _ t'-......Size: Diameter_ '".A,�=-- Depth :`.... Cesspool: Distance from nearest well.................Distance from foundation....................Lining material............_........__.............. \ „ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well ---------------------------------.--------------Dis nce from nearest building.......................................... ❑ Distance to nearest lot line---------------------------------------------------- ................ ...................................................•--••------- Remodeitng d/or epairing e):._ �''` :_ ^.C'- - �—a�f �- I hereby certify that I have prepar this appli tion an hat flo work will be done in accordance with San Joaquin County - ordinances, S to laws red rule nd tion o e Sa oaqu' ocal � y ......................................................... - Healt District. .. .•-••O..w(Signed)-- -_- ............ ( _ /or Contractor) By:... ••.•..... -------------•-•- . --------------(riifle)---- -- Wit - - ................. (Plot plan, s of 10t, 1 on of system in relation to wells, buildings, etc., can be p a` d on reverse e). ORD ARTME T USE ONLY APPLICATION ACCEPTED BY......... - -- ------ ---- ------------ --------------- DATE----------- -30- :_. -- REVIEWED BY...................... ....... ---- ----------------------------- ...... DATE ............................................................ BUILDINGPERMIT ISSUED...... - ------------------------•-----------------------------------------------------•--.... ••• DATE................................................... ••--•- Alterations and/or recommendations:-,4,11k--- 4. -,e ? -------------------•-------•--.....------------------------------------------------------.......-------------------------------------------------------------•--••---•---- ----••••••••............---•-••-•-•_.... ------------•----•---------•.._..--•-------------------•-------------...---------- .---------------------------------------------------•-----------•-----•-------------•-----------•---------------------•-•-•---.....I.... -----------•---------------------------------------•--------...------------------...---....-----------------•------------------------------•--------------------------•---------••-------•.•----------.....-••-•-•••-••••--- ------•---------••••••-••••-•---• -------------------------------------------------------------------------------------------------------------•---------................................................................ NAL INSPECTION BY:-----Q......... ---------------------------- Date..... ..-----.............................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 18Eo 8-89 YM 5-61 ATLAS