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------------ ------- ---------- ----------- --------- ------------, ---- --- APPLICATION FOR SANITATION PERMIT Permit ----------------------------------- - -------- (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issuedl/ . Application is hereby made to the Sen Joaquin Local Health District fora permit to c Date issued .__.. % lel This application is made in compliance with County Ordinance No. 549. x'_�St7-33 p construct and instpll orkh�n described. JOB ADDRESS AND LOCATION-_ _ -----Rb, ' Owner's Name_��:L�,.� 1 ......../- .._..�n__�.,xti------ -- " f Address.-P -� s + o -- X -- IQJ Contractor's Name---- ----------------------------------------------- ame._-. (� - --•- ----- Phone Installation will serve: Residence ❑ Apartment House - ------•---••-_----•----•••-•--�•••_��---••-� - Number of living units: . Number of bedrooms y Commercial ❑ "Trailer Courttel ❑ Other [i Water Supply: Publics stem Number of baths ._ Lot size ...... --•- I G �,� Y ❑ Communi system .............. Character of soil to a depth of 3 feet: Sand Grav� Private .� Depth to Water Table .0 . ft. Previous Application Made: (If yes,date--------_----------- N❑, Sandy Loam ❑ Clay Loam ❑ Clay C1 Adobe❑ Hardpan❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' iE New Construction: Yes �o ❑ FHA/VA.- Yes ❑ No (No septic tank or cesspool permitted if public sewer is available within 200 feet.) WWt'ic= nk—i '"Distance.from-nearest-well=�00� i D.istance.,fr m foundation.--I�.__ No. of compartments_.___,-_,' - Size: ► - - . ---- - ..Mater; .t -_-Liquid depth Disposal Field: Distance from nearest well-_210C,- ---Capacity`; � Q Distance from foundation.._, Di tante to nearest tot line. Number of lines ------------------------ -- -•--- --- - -- Length of each line_.__:__ --3,---,Width Width of trench.__, --- � Type of filter ma+erial._ _Total length__---••- _ Q t -•-ROC a Depth of filter material___ ^ ' �` 1v Seepage Pit: Distance to nearest well----------------------Distance from foundation--�---.---_--.Distance to near ❑ Number of. Pits.-- •------------Lining material-------•--- • est lot line_.__..__•--•__-_ � Cesspool: Distance from nearest well----------------- ---`-----Size: Diameter-----------------------Depth______________••-___•--•_ {� ) _--•• Distance from foundation_____-_____._•-: Lining material_.___._.._•••--_---•__ ❑ Size:iDiameter --------•-------------Depth-------------------- Priv Liquid Capacity 1;2 f. Y� Distance from nearest well=_-----•-------------------- q p �'•------•--••-•---•--....__..gats. ____________________Distance from nearest building Distance:to nearest ]of line g--------._.•------ ------------------------- - Remodeling and/or repairing (describe)--------------- - �-- i ---------------•- •---------- - --------------------------------- -= -•-•---------•-------•------•-------•------•-------•-------------•--------------------••-----•-------•--------•------------ •- e y p per- -' -ti• ------•--------------------------•-------------------------------•-------------------•-------------- --------------- ------ I herebycertify that I have re ared this pplicetion and that the work will be done in ac ' ordinances, State laws, and rules and eg o the San Joaquin Local Health District, cordance with San Joaquin County i� t (Signed) ,(.- f -------------•---------- ( By-- --=--------------------------------------------------- (Owner and/or Contractor) ++1" (Ow d/o p g - (Title)------- ----- Plot len, showin size of lot, location of system in reletionjto-,wells, buildings, etc., can be placed on reverse side). iFOit DEPARTMENT USE ONLY,_'— APPLICATION ACCEPTED BY-__-�-�_..Cj- --=�- ri-------•---- - REVIEWED BY_._. .: DATE...... ��P BUILDING PERMIT ISSUED_.._ _ '. - -•---• DATE------- ------- ------- -----•---•---- ---------------------------- -------------•------ -------- AFFerations and/or recommerldatians--------------------- -- DATE-------...--•-------------•----------•--•--•----------•--_--- f -----------•------ 1 .............__._..e ------ ......--- .+'F' i ---------------- ----•------ --------------------------...--•--••-----••------...___------••-•--••--_- •-� . ' - 14 FINAL iNSPECT40N BY.:.. Date--- ---•--- � -- •----------------- 130 South American Street SAN JOAQUIN LOCAL HEALTH DISTRICT �\ r } 300 West Oak Street Stockton,California '144 Sycamore Street ; Lodi,California 205 West 9th Street ra s rrtvisco s- Manteear California 89 PM S•41 ATLAS Tracy,California