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i-UKUrrlC.t UJt: e - ----------- ---------------- -- - ---_---_- APPLICATION FOR SANITATION PERMIT i-Permit No. :_� f .. - -° ,�.. (Complete in Duplicate)1 #Tate Issued -------- ---- This Permit Ex ices 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit.to coneKic.fr:end install the work herein described. This application'is made'in compliance wifh County Ordinance No. 549. JOB ADDRt�'..�' •; - ~ - ; SS"ANDLOCATION....�- - TH..... 8 L - 1 I"!_!q_ CA Owners_ ame;S..� �_-t`:F _R. _:...:.. Ar _ -----••-------------------------------------------------------------------------- Phone.!!`�7_'_3` 3_ _ Address.----• `�L------_ ! RT..!~�"""'#Qt'*9 ll ................... l r -------------------------------------------- Installation will serve ft F:�..................... ...................................................................... .._. Phone............................------ ' Contr6ctor s Name... _.. _._ dancepartment House ❑ Commercial ❑ Trailer Court ❑ Motel .E] Other ❑ Number of living units: __ _ Number of bedrooms, Number of baths _�._. Lot size ...__ Watei Supply: Public system ❑ Community system I] Private ]Depth to Water Table/- ft. Character of soil to a depth of'3 feli f: Sand Gravel �1Sandy;=Loam. ❑ lay Loa ;❑ Clay ❑ dobe❑ Hardpan ❑ , Previous Application Made: (If,yes,date-------- --------) No ❑] 4New,Connsttrruction: Yes ❑ No ❑ FHA/VA. Yes ❑ No ❑ 3 w -.� 1.r: .�. Mee TYPE__OF_INSTALLATION .AND-SPECIFICATIONS: -� ' - ,- - •�• _ . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well_/P0..Distan from foundation_-__/- .-__---.Material_-KEDWQp.p............ r No. of com artments_ ---:.-Size_i __ op.0 P -----�---- --�-- -X:�_Liquid depth--s.�--�---�---.....�Capauty._1... .. ._. p ...../0 to nearest to ling.__„ osal Field: Distance from n�arest ell-��,-..-Distance from foundatio .... . � ..___.._ Number of linesl..�_ ...Len th of each line_._.- Width of trench..:_ is r: b'- -- -•----- Fs Type of filter m9terial__R_O_C.K_.__.Depth of filter material____Z9------------ length-!...si :' ........................... Seepage .Pit: Distance tonearesfi'well � �"!4!Distance from f�o'�unda bn.._j_(,�_-•-_-_•_-.Distance to Aarej-lot li Number of pits......... g �' °i Linin material_ Q_� ..---Sizes Diameter _ _-- i —Bepth- - -------•-------•-.--. Cesspool: Distance from nearest well-----------------Distance from foundatl --w_*-_-/ALiXngial..-.. --------._.................... Size: Diameter------------- ---_-----Depth-----------------------------------------------------Liquid #-------•-----------.-_- als. Privy: Di tante from nearest well-------------------------------------------------Distance from nearest building--__--;__ ....:.___._--__---------.-. Di ante to nearest lot line------------------------------------------------------------------------ Remodeling'l'and/or repairing.(describe)=------------------------------------------•----•------•-•-----------------•---••-•----•------•--•------..._..---1_74.-----.....---............-- ------------------r'---------.-----I----------------------..--.-------------•--•- ----------------- ----------*...... •------------•--- --•-------------•--•---•----•-------------..------------------------------------------------ ----------- - - Y - y--------------------p..-------------- ------- - •------- ---- ---------:----------------,-----------------•.------•----------------------. 1 64 certify that I have prepared this application and that the work will be done in accordance wtth n. •u1 Sen Joaquin County ordinances, State laws,Viand rules and regulations of t e San Joaquin Local Health District. (Sig�ned)... "� - -----------_--------------------------- -- --------------- ---(Owner and/or Contractor f✓ By:....................................... _ -- _ _ _ - � -""- _- -- _,--- (1 itis)---'-- _______________ ___ ------ -------------- (Plot plan, showing.sizetf lot, locafion..of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLECATION ACCEPTED 8Y ` P� Q"_-.-.--_- -'�f; _ - -- - DATE L _ '6/------------------------ REVIEWED BY- A --- -- ------------------ ---- ---- --- DATE S ..-•---•....... BUILDING PERMIT ISSUED-------------------------------------------------------------- .. DATE I ------------- Aherations,and/orrrecommen ations:._-- . .. --.- .... t---. ----- - -- -- ----- ------------------------------------------------------------ .. . ...................•--•-------.--•---.----._.............-.•.--.. ---------------- •------- —..ti..�-.- .... - ------ ----•---------- FINAL INSP_,_-� - - ------ ----- - ----- Date----- .. SAN JOAQUIN LOCAL HEALTHDISTRICT 130 South American Street 300 West Oak Srreel 124 Sycamore Street 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California F ES 9 REVISED 8-89 2M 8-451 ATLAS ti • � A 1 4