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" FOR OFFI aE USE: - ------ ---'--------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -•-•--------_-----= -------------•--------•----------------- --------------- (Complete in Duplicate) Date Issued .___.__..jfa/._7_/ , ---- ---------- ------ -- ------------------------ m Date-------- This Permit Expires 1 Year From Dame Issued Z ...��"" oe :3W^ _p Application is hereby made to the San Joaquin Local Health District for a permit construct and install the work herein described. i This application s made in compliance with County Ordinance No. 549. MPNTIECJq JOB ADDRESS AND`LOCATION.�` ___ ----- I ----..-I--►"I_G�NTA�- �?_�. h� f U' ��F--1 �Y....z'Z�._..-- Owner's Name__. t S' . lv- ------- ST Q M1 ------------ --------------- --•------ -------- Phone_.-.-, '_3.7,.0 Address-------•--•--•---...�©.........................................../ ---------- ' - ------------- i.......... .. Phone Contractors Name...... .f�.I e............ + Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �rfoM Number of living units: J____ Number of bedrooms 12 Number o baths _3__ Lot size ........j,7_....__ 9L.-RE7S----------------- Water Supply: Public system ❑ Community system ❑ Private 8 Depth ro,Water Table „1.- ft. Character of soil to a depth of 3 feet:. Send [Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Appiication Made: (If yes,dat --------------------) No J;a`� Nerv;Construction: Yes ff""No [:1FHJA/VA: Yes ❑ No TYPE OF,INSTALLATION-AND=SP_ECIFICATIONS:- - t - �- _:�_ � — _ _ - I (No septic tank or cesspool permitted if-public-sewer-is-available within 200 feet.) Septic nk: Distance from nearest well_--.,,7�.- _-Distance from foundation___A�________.Material__�� of ompa tmei s------ -Size_? �r�af Liquid depth_____-3�_.�__,.__Capacity.-3-0-00-09L-51 Disposal Field: Dista a � o. Distance from neer st well___-_..Distance from foundation___��__-_-_.Distance to nearest lot line...••__.___._ Number of lines._...-----.._ g 11 • �� ________________Length of each line p /E? ''_� F.Width of fr�nch._� __.____4__�y__�.__ Uj Type of filter materiel_________________________Depth of filter.material----._---•__-_.-____-__Total length______-•___-__.-______________________-.__ - r Seepage Pit: Distance to nearest well---------------_------Distance from-foundation....................Distance to'-nearest lot line................. p ❑ Number of pits_____________'------Lining material------------ --------Size: Diameter__--.....-,.• -----._.Depth--------------------------------- Cesspool: Distance from nearesffwell-----------------Distance from foundation____________________Lining\r aterial.-------------------- ............... ❑ Size`�Di�meter._._i.-•---------------------- - Depth--------------- - ---• -___-:-----------------____Liquid Capacity----------------------------gals. Privy: Disi-ante-from•.neprest'well------------------ ------------------------------Distance from nearest building__` .-.---------.-..-----...� ❑ Distance to nearest lot line------------- ------------------------------ - -------------------------------------------------`-'---------------------------------------- Remodeling and/or repairing (describe)--------------------------------- ----- ---------------- --:------------------...-------•-------•--`---------•-- ----•-•-----------------•---•--• ---------------•------- - ------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- f i 1 I hereby certify that I have prepared this application and tthaf the work will be done in accordance with-San Joaquin County ordinances, ate I ws a d rules nd regulations of the San Joa.qui_n.Local,Health District. (Signed)------ --- ----- - ----------------------------------------------------________r"_-`'"__- ---------------------------------------Owner and/or Contractor BY=--•-----•--•............... -- - ---- -----------------(Title)----- n_ _ _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------_�__.c_ --�O..c--------------------------------------•--••-•------•----------_ DATE..... r� ------------------- REVIEWED -•---•-- -REVIEWED BY----------------------------------------------------------------------------------------------------------------------------_-DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---------------- ---------I------------------ ---• ....--••----------.....-----------------------------------_------•---------------------------------------- ----------------------------- --------------------- ------ { --- f_______________________________________•_-___.-__.____-_..______.._____...__-_____._.______.-_.______.._._.___.___________________________--_--__--__.--------___---_--_.-___..______.._________..__-___--____.-___-.-_----.__ F • k FINAL lNSPECTI Dat e ' . !_-/' r. ----- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5.82 ATLAS