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---------- - ----------------------------------------------.----------- APPLICATION FOR SANITATION PERMITPermit No. ..� ------------------ E,--------- ••---------- (Complete in Duplicate) r 110 � `/�.2� ------------------------------------------ --------------- This Permit Expires 1 Year From Date Issued $Z9 Date Issued .____ __ 6 Z 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 Co my Ordinance No. 549. JOB ADDRESS AND L ATION ` �__: ----------................. � l Owner's Name--------------- J6... I _tT_ p.Sp ` -.. _--__----•-------"----- Phone.. 1_--- ..X— z-- Address-------------------- ---•............................. ------------------------ - -- -------- ---- ----•--------------------------------------------' ---------•-•---------••---•--•-•--•-•----•--- ,, 1 / 7 Contractor's Name...-------•-•-•-•------ ----------•---_...-••-•-•----•-- -•-•- -- r.----lAjel--'--------------------------- Phone./k9..GP Installation will serve: Residence 19 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- .-I.... Number of bedrooms -_Number of baths _1_____ Lot size __.__&---ax_1.IZ-5......................... Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe"'Of Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 0, New Construction: Yes ❑ No a FHA/VA: Yes ❑ NoX 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................................................. ❑r Xl54105' No. of compartments--------------------------Size--------------------------------Liquid depth-------------------- Capacity Disposal Field: Distance from nearest well-________________Distance from foundation....................Distance to nearest lot line................. ❑g'> 15.kj4G Number of lines------------•----------------------Length of each line------------------------------Width of trench.-.----------_-_--------_.__ Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well---NO ....Distance f&om foundation-_m3l.!.......Distance to nearest lot line... Number of pits--- --------Lining material---R ------Size: Diameter_....5 ..........Depth""""_:2 ............. Cesspool: Distance from nearest well------------_--Distance from foundation--------------------Lining material............_-_............._...._.__ ❑ Size: Diameter--------------•---•--- ------Depth--------------- ---•------------------------------.-Liquid Capacity----------------------------gals. \' Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_.__--"-_.__________-_---------_---------. ❑ Distance to nearest lot line------------------------------------------------ --------------------------------•-•---... Remodeling and/or repairing (describe)----- ------- - F ------------ --........ ----••---•-•-------•-•---•"-•-" ...... -- • --------- ! �.. - - --- --- ---------------------------------- ---•---•------------------------------------------------------•--------- ...........------------•------"-------------- -------------------------------I--------------------------------••---------------••-•----- --------- ----•--------------------------------------------------------- --------------------•---------------------------------•------------------------------------•-------------•---••----------•---•---------------- I hereby certify that 1 have pLepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and es an regulations of the San Joaquin Local Health District. (SI ned �t/�-�, ""."""- "-(Owner and/or Contractor) 9 ) ............. . �t4,44 -- ------"-------- -- ey:--•---------------- `{ .---•------ i4-!? ------(Title).......!�_•"�; - - -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ,!OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ....-_------------- DATE--------- —----------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-------•---•--•- BUILDING PERMIT ISSUED -- --•--------------_----------- ----- DATE. --------------- ------------------------ - - - - -- -- Alterations and/or recommendations:__ _. _ -__ " _4_-, �-(Q ---------------------------------------------------------- --•------•-- --- ------------- .--- -------- -- - -------------------------- --•------------------------------------------••-----..-...- ------------------------------------------------------------ ✓ FINAL INSPECTION B :---- --- -- ------ Date------------ ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 724 Sycamoro Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EE 9 REVISED 5-99 2M 5-61 ATLAS p