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FOR OFFICE USE: ------------------- ------------------------------------ ~ ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...�1� � ------ (Complete in Duplicate) -------------- -------------- This Permit Expires l 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 LOCATION._ __.. __._M.r.F-----E____or-_ _ PPoA-r-.L V...�I -...... - -----••-- •�� ------- Owner's Name____...S1-M------------- } ---`---------•-•------•--•------------------------------------------------- Rewe CAS � Address.-------W------!_7_w ---- ..Z_0 c rp q Contractor's Name..----M_j9.E�T —FR � Phone... .. Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other [3 Number of living units: ..-_. Number of bedrooms3 _ Number:of baths __-... Lot size .. _( . _..., .... .0.0-•-___.__•___._.__ Water Supply: Public system E] Community system C1 Private .. ;Depth.tb.tWater Table 10 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam layf Loan ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------_----------) No Vj-'New Construction: Yes 2"No ❑ FHA/VA: Yes ❑ No y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- {{ Distance from nearest well_________________Distance from foundation.....__.___________.Material-------------------------........................ No. of compartments--------------------------Size.......... ---_----------------Liquid depjh--------------------------Capacity....................... Disposal Field- Distance from nearest well------------------Distance from foundation---------------------Distance'.to nearest lot line..............•.. �JXf 'Number of lines-----------------------------------Length of each line--------.---------------------Width of trench_.)------------------------------ Type of filter material.-_____________________Depth of filter material..---------- _______Total length__________--____.----------------____.____ ��Seeps a Pit: Distance to nearest well------��_____.Distance�om foundation___________________ istance�to Weare## lot line--..15— WHO ine__-. � ��q I(N Numi�er of pits...... Lining material__ _ ©�K--Size: Diameter_ Depth,___- RP CjA r Cesspool: D ance Trom nearest well-----------------Distance from foundation---------------- materlaL--_#-:_-__..-.-._____.____.__-_.___ . Size: Diameter----•---•-----------------------------De th--------------------- -----------------------------Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------- ---------------___.____.._..___._. Distance to nearest lot line------------ --- ----------------------- -----------•-•-------- ! � 114A&41AAf! � 1 A - , -------------• ----------..._....-----.......---------------------••----•---•---- Remodeling and/o- repairing (describe):- --••-•----•-- ------------------------------ - ------------------ ------------------------------------------------•- i •----------------••-------•-------•----•--•------------------------------------------------------------------.-.---------------- -•------------•------•-----------•-------•------- -------------------_-------------- -- I• .W T ! I hereby ce 'fy that I hex prep red this application and that the work will be done in accordance with San .Joaquin County ordinances, St .e aw and rule a egu I s of the San Joaquin Local Health District! T- 5i �ned _ _________Owner and/or Contractor BY:----------------------------------------- ---------- ----------------^---- ---�---------------------------------------..(Titlel.T •---- - (Plot plan, showing size of lot, to tion of system in relation to wells, buildings, etc., can be placed onf-reverse side): . -t ti-may . ■ �..� FOR DEPARTMENT USE ONLY 4/+ � APPLICATION ACCEPTED BY---------l----!_�-` ---- •---•----------------- DATE----------/ - REVIEWEDBY----------------------------------------------------------------•-- ------ DATE----------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE............__._.-------------------------------------•---- Alterationsand/or recommendations----------------------------------------------------------------------------------------------------------•---------------------•---------- -----•------ y � Z��- FINAL INSPECTIO .. . -- - - - - • -•- ------- --- -� -._ . . .�,�.�"7 f Date-------- ----------- ----•---•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California ES 4 REVISED 8-89 2M 5-61 ATLAS