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FOROFFICE USE: ---------------------------- -• -- .. ' .. -< . _ APPLICATION FnR SANITATION PERMIT Permit No. ��.��.a� -------------------------- ----------------------------- (Complete in Duplicate) ---------------_---------------------------------------- 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 inst I the work herein describe . This application. is made in complianceih CountyOrdinance No. 549. tMANTEZa AREA JO[3 ADDRESS AN�DI - 1 -----1VOQ_Q..--- -- Tr.------•-- [ . -�.�_Fh1�}- 1[Y_-_-... -- Owner's Name------..1jn!-12.x)rM........I---------:5 14------- -------- Phone___�I1 Address-=----F?TF----j--` .. �'�i __._. . .. 0_.P.A---------------------------------• -- ------•----------•-•---•--------•-••--- Contractor's Name....£.13±ENErn'1....................... r -- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ �Other ❑ F Number of living units: 1-0- Number of bedrooms _ Number of baths __!!�Lot size ....... •`---- ; Water Supply: Public system ❑ Community s tem ❑ Private Depth to Water Table/©- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ '-Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-_.________________) No� New Construction: Yes o ❑ FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND'SPECIFICATIONS: LN (No septic tank or cesspool permitted if public stwer is available within 200 feet.) 00 Septic- ank: TDistance,fro m-nearest well__--==_:..D1stan e;f foun�dation....1..-°__. tetial____��P-�e:�.E -- % t2�?r �------- � 7 -��._,-..Liquid depth--• ---------I------Capacity--•7 ..~ No. of compartments-_-S. ..Size. . . •- Disposal Field: Distance from nearest well_- .._...Dista.nce from foundation..---/O------__.Distance to nearest lot line_. _ 7_...... Number of lines......... ____ _____________Length of each line�iQ.e .% ----.Width of trench.. -T ... -- - T�'� Type of filter material; '0 ,K-Depth of filter material____.-/.___........Total length_...-. .�?�..._ '.__ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line___-._---___.._.. E] Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------,Depth.................................. �Id Cesspool: Distance from nearest well-----------------Distance from foundation...............-----Lining material--------------.....________-•-..a_._ o ❑ Size: Diameter------------ -------------------------Depth.---------------------------------------------------Liquid Capacity.....--•------••--------•---gals. 6 Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building.............______-----.----__ ..___._. ❑ Distance to'nearest'lot line-----------------------------------------------------------------------------•-------------------------------------=-----_--------------••------ Remodeling and/or repairing (describe: --------•--------- ---•-------------------------------•---------------------••.-------------------------------------------- t ..:....:__.•-_•____________________________________________________________•••--___.___._________------____.__..__._-________---__________.»..-_-_________-__--______..-__.______...._.__...________._.__.».__________._____ _ -- __________________________ ____________ ____________ ________________________________________________________________________________ _- ____________________________________ _ ____________________________________ t { _____________________________________________________________••_______._________-._____-__----_____._.-.___-.--________-_----_____.....__________•----____.....___._..____•----------•._..-_______________-_--__-______-...--- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat la , nd rule and re s the San Joaquin Local Health District. (Signed) - `....... - -- -- -------- --------•-----------------------••-------•-----------------••----(Owner and/or Contracforl By:•--•---._..¢.........---•------------•------------ --------------•-•----------:-------------------------------------------------(rifle)-----------•---------•---------------------- -------- - (Plot plan, showing size. of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). --`F(-SIt pEPAR MEENT JSE ONLY APPLICATION ACCEPTED BY T' 'Q`---------------------=------------------------••-----_----------------- DATE___JA____ /1--------/------------------------- RE=VIEWED BY...-•----=------------- •--••----------------------• -------------------=----------------------------•------------ DATE ----------------------•----••---------------------- BUILDINGPERMIT ISSUED.--_------------=------------------•'•- -= ---------------- ------------------ DATE-------•---------------------------- •------------- Alterationsand/or recommendations:----•---------------------------• ---------•------•---•---------------------.-.--------••-----•-------....-----••--------------••---•--------------..-..-----• f - - - ---- ..---,...-..-.---•--•---------••---------------.. ---------••-•------ - ---cit- ---------------- ... - -----•-----------------------------•-----------------------•-----------•------------------------------- E - FINAL [NSPECTI®1 . = Date.--- / e`~ - SAN JOAQUIN LOCAL HEALTH DISTRICT kti f S t 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISEn 8.99 YM 661 ATLAS