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_ APPLICATION FOR SANITATION PERMIT Permit No. ...� --------------------- ---------- (Complete in Duplicate) -- This Permit Ex ires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District Date Issued ..__.� z r This application is made in compliance with County Ordinance No. 549. p� rct for a permit to construct and install the work herein described. JOB ADDRESS AND LOCATION-1471 ---- _..0&'.44, Owner's Name..----606_4r� -----------------•-----------------•------•---......----Address.• -----•------- •------------------•--- Phone---•-- Contractor's ............................Name - ------------------------------------•------- Installation will serge; Residence t Apartment House Phone............... ............. Number of livingunits: Commercial ❑ Trailer Court ❑ Motele❑ �-- Number of bedrooms _ Other ❑ �..__ Number of baths .r --_ Wafer Supply; Public system -� Lot size ....../4ac j6Z� r Y Community system :;;:A"-`-'"'-' Y Y ❑ Private ❑ Depth to Water Table 42 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam Previous Application Made: (If yes,date__________ �/' Y [:] C1aY [I Adobe❑ Hardpan 0 TYPE OF INSTALLATION AND SPECIFICATIONS:- ) No LK New Construction: Yes Ql,' �9?"' FHA/VA; Yes ❑ Nd4? - it (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septank Distance from nearest well-----------------Distance from foundation____.----- No. of compartments-------------------------Size- -------.Material---------•---- ..._....._......... Dis I F'el •--•-- ---Liquid depth--------------------------Capacity p Distance from nearest well_________-_____-Distance from foundation-----_--------------Distance to nearest lot line_..____..._._..._ TypeNumber of lines_.-----•---------------------------Length of each line------------------------------ ' Type of filter material-------------------------Depth of filter material-___•---------•--- -Width of trench------------_----_--------- .it: Distance to nearest well_ Tota! length_--•--...--- r -- Distance Lm f undation__ (./�,►.iy.Distance to nearest lot line_-, _ Number of pits "_�--_---_"-_-Lining material__' _ (".�- - --_--Size: Diameter.___ 3 Cesspool: Distance from nearest welt-----------•-----Distance from foundation-------- - ----Lining material _-- +1`'..._. ' ❑ Size: Diameter._----------------•--- Priv -Depth Liquid Capaci --- ------------------- ------------------------------------------- ` tY------------•--•---•-----•--gals. Vlf Distance from nearest well_"________________ "-__ __ Distance from nearest building Distance to naarest�lot line Remodeling and/or repairing (describe):-- _"-_" -------------------------------- ---------- --•--•--------•--------------------------- ----••-------•---------------------------------•----•----•-- ----------------- --------------•--- ----------•--•----------•-•-•- �---- - ----•------•---------------•-----•--••---------- ------ I hereby certify }hat I have prepare k10 plication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r the San Joaquin Local Health District. (Signed)------------• - I -------------- ------- ------•---------------------------------- 8Y: --• •-- -------- (Owner and/or Contractor) {Title) (Plot plan, showing size. of iot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY_. ... .__ - ---------------�------------------------------••----------- DATE---- �� ---��.-� REVIEWED BY - - r^ ------ BUILDING PERMIT ISSUED •- -- ------------------------ - __ DATE-------- T .- --Alterations and/or reco mendations:------.-------- DATE_-----•-•--•--- •-•--• ---- -• — ---- -- - --- -.---- --•------•--••----- ---•--�--�- - r ------------ r J_ ----------------------------------------- -•----------- - -•-- - F1NAL INSPECTION BY...._OZ._, Da 130 South American StrewSAN JOAQUIN LOCAL HEALTH DISTRICT Stockton,California 300 West Oak Street 124 Sycamore Street Lodi,California 205 west 9Th Street ES 9 REVISED 5-89 8M 5-61 ATLAS Manteca,California Tracy,California