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FOR OFFICE USE: ---------------------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. ...,�..� r� - --- ------------------------- -------------------------- (Complete in Duplicate) _4 Date Issued _1_________________________________ ______________________ This Permit Expires 1 Year From Date Issued - ------•----•--- —/ --r Application'is herebyrmade.to the San`Joaquin'Local'Health District for a permit to construct and install the work he in described. ,Th- application.i .made in compliance withOrdinanc No. 549. ,N TEC.14 JOB AI]QRE55 AN OCATIO-`. ----- --------- /"' ` '� ----- ... r `'�...... Owner's Name--• --- •--- •--tit--�-- ---- -------- --- ------------------------------- --• --------- r'-: ----........ Address----•.. _ C? . _�........---•-------------------- 5_1 Contractor's Name-------------AE.-i -.... ---- -- -! f Phonal., ti Installation will serve: Residence ❑ Apartment House Comm�is l ❑ Trai1 r Court ❑ MoteIJ3 Other ❑ Number of living units: ___�__- Number of bedrooms. umber of baths .... Lot s ... ._.._.�____ .`. ......... t i f(�_ ft. Water Supply: Public system ❑ Community system Private Depth,f Water Table 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 ❑ No C nstruction: Yes No ❑ FHANA: Yes ❑ No ❑ TYPE`OF`INSTALL'ATION'AND -SPECIFICATIONS: No septic tank-oc r es s pool permitted 4f public sewer is availabl' w�[[ithin 200 feet.) Septic T = P Distance from pearest well_� ._____Distance fromfdu� ion... 0_.__._...Materie€__ . . ................... No. of compartments--------fes-.------.. - pac2 �..., ' C Disposal F' Id: Distance from nearest well---- t j--•••• -••••- p ____._._.Distance from�fo�ndatio Distance to nearest lot line_._ Number of lines____________ _____ ___ ength of each�,line___.__, _V_ j�_._.Width of trench._....._____ _____-.._--- Type of filter material._ _.�epth of filter material___ _`tl___ ..-.7otal length......_ 0._ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. 1 .P_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------------- Depth--•-- •----------•------------._ P e tion--------------------Lining mater ----------•---....- ial...,_....__.:.----- Cesspool: Distance from nearest well........-.........Distance from founds • Liquid Capacity ❑ Size: Diameter- ---------:•-------------- --------Depth-----------------=--- -!- •---------------- q --......._..----------------gals. Privy: Distance from nearest well----------------------------_---------------------Distance from nearest building-----------------:________._....... [] Distance to nearest lot line - ---------__-•- -•------•-•----------------- = ............ Remodeling a d/or repairing (describe): `=-=- ------------------•-••---`--- -------------------...........-----------•- i P`_._ .1 •-�.1-�lrr° -I.�U Xr ,�`�r �` - R--- rkK-----L 4n r�dnr----------------•---_-----_-.--------------------- �.------------------------------------------------------_----_..-.----- ---------------------- . ------ ------------------------------------------------------------------------------------------- ----------------------------•--- ---- -----------•--- ------- ---------------------------------------•--------------- - ---- -----_----------- I - -- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St �and- s a reul`ations 0f the Saii Joaquin Local Health District. : (Signed)__ .. �J< _ .__ _ ____ _. _-� -_ - T,[Owner end/or Contractor_ ,_ i - _� .. -. - r_ By----------------------------------------- -------------------------------------------------------- ..............----------_------(rifle)-------_----------------------------------- ----------------- (Plot plan, showing size of lot, location of system in rela+ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- 777-B-'-0!----------------------------------------------------------------- DATE---------- --.--------- 'f REVIEWED BY------------------------------------- C, � DATE----------------------------------------------------------- BUILDING PERMIT ISSUED - ----------------------•----------------------------- .._.. DATE I Alterations and/or recommendations:----- '`[�1 .----wwt......./ T`E} I•- -------I PI QUI ............ !jz?�_o....... 7 ------------•------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------- ------------------------- ____________________________4.._._..__.__ ---------------------------_.-------------------------------------- __---------------------- :__.__._---.--.-_--_._._._--._____-_-----___--_-________--_- - •-' --------•-------------------•----•--•----•.---` •--------------•- i------------------------------------ a • f' � ` FINAL INSPECT tQ Date--------------- -�/ ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California £A 9 REVISED 8-S9 RM 5.61 ATLAS