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FOR OFFICE USE: R � - -------------- ------ F. _________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ..1�_. �--- ------------- 4 (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 install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND .....41,okl........ ........I........=..........�ATRROP.................................................. Owner's Name.......wo4laTEK.......... - --------------------------------------------------------------------------- Phone.................................... Address JQa - ------------•-••---•---- 1 Contractor's Name.....MADER e. --- - --- - ---- - -------•..---------------------------------------------•-------•-•------------- Phone----•--•---•-................................... I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .11----- Number of bedrooms 4._._ Number of baths ___I___ Lot size .........57.........._.. Water Supply: Public system ❑ Community sys m ❑ Private �epth to Water Table _1.2--ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam O -Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No Wl/Klew Construction: Yes &-_'No ❑ FHA/VA: Yes ❑ No�' TYPE OF INSTALLATION AND SPECIFICATIONS: -- -a—(No-septic tank:.or--cesspool-permit#ed;if=publi -sewer-.is=available-within-200 fee#) - f4 �--�--r- Septic Tank: Distance from nearest well____________ ___Distance from foundation.-I.0_..__.._..Mate IaL___. AJ [p/ v XS_.. Li uld depth .` Ca aci " OP �L No. of compartments-----�---------Size-- 1�--�-- -- - --- q R --------•- P tY,--•-�---........� Disposal Field: Distance from nearest well - .-__.__Distance from foundation. Distance to nearest lot li n,?�...... Number of lines___ _-_.!;A ^ -......Length of each line ..,W- Width of trench... .' y'..... ____..__..� Type of filter material Depth of filter materia -----------Total length----._._.. Seepage Pit: Distance to nearest well-------------------a.Distance from foundation....................Distance to nearest lot line................. ❑ Number.of pits----------------------Lining material-----------------------Size: Diameter-----------------------,Depth------------------- _.......... \ Cesspool: Distance from nearest well-------------- _Distance from foundation--------------.____.Lining material..................................... ❑ Size: Diameter----------------------------------- Depth------------------------------------- --------------Liquid%Capacity............................gals. \� I Privy: Distance from nearest well----------- _____________________-----_-._Distance from nearest building.......................................... v) ❑ Distance to nearest lot line-==--------••---I--------------------- •---•-------------------=-------------- ---.--------•-------•-----•----------=•---•-•---------- Remodeling and/or repairing (describe)--------------------------- --------------------- •----•-----•--•-•• ----•------•----•------•----------•----•-•------------•--•-•-------•--- 4' `-- ------------------•----------------------------...----------------------------- 4.11 -------------------------------------------------------------•------ --------•---------. -•----------•-----------------••-•-•--•-----------•------•..........................................--••------ ....--- I hereby certify that I have prepared this application'and that the work will be done in.accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, ned 17��t- --=----------------------------------------•-----------------------------------•------------- - (Owner and/or Contractor) ; Si( 9 )-- ".6 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,.-canwbe-placed on reverssze side). .41FOR`DEPARTMENT USE ON.L I APPLICATION ACCEPTED BY_ ___ _- _._ p ---------------- -------------- DATE REVIEWEDBY-------------------------------------------------------------------------------------�------------------------------------ DATE------_------------------------------------- BUILDING PERIvi,I.T ISSUED-------------------------------------------------------------.......-••--•--••------------- ...... DATE ti is and/or recommendations -_..__--_._ :_. __ ...,, ,, �f / `7i�', ll "P1�Q � 1 CQn� ?�c1 _T/Ur _. ..7►R.O; - ----- .... ----- ..................... FINAL INSPEGTION-B _ --- - "" "..M` "...-'----•----- Date..... . -� SAN JOAQUIN LOCAL HEALTH DISRIC .. 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 8.89 2M 5-61 ATLAS �_ 1