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,-UK Ut-Hu USE: APPLICATION FOR SANITATION PERMIT Permit No. ..,1 .771 ----------------- --------------------------------------- (Complete in Duplicate) ------------ This Permit Expires 1 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. 2p e--rcr?d�(q JOB ADDRESS JA10C TION--- c�.�.'�-------1117LA2QL ............ Owner's Name ...:-�� _1\fS_t)�LF—__.--------•----------------------------------------------------------------- Phone _ _ + . Address-------•- A --- p11�TL ------ X ----- J_j-----In--------- - -- -----6------------------------------------------------•-•--•-- ------•-• Contractors Name---' '� /y"ll 'i77 � 1.. 1 ------------------------------------------.---------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 0 Number of living units: ` ^� i...-. Number of bedrooms3-- Number baths __�1_.—.. Lot size ._____��r�___.-..�___.�1__,_____________ Water Supply: Public system"D Community system ❑ Private Depth To Water Table:�P.. ft. r _ Character of soil toe depth of 3 feet: Sand Gravel ❑ Sandy Loam 2�r Clay Loam ❑ Clay ❑ Adobe❑ Hardpan �3 Previous Application Made: (If yes,date______________ ____) No IJ New Construction: Yes ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: " • `'� __ _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic rik: Distance from nearest well----5©----Distancesfrom foundation----/iQ_____-__.Material----fOjvcpt -_---- No. of compartments J( >( Liquid depth--- -- ---------Capacity,12_4 Q_.__. 1 P �.-----------Size- -- ••----.. Disposal Field: Distance from nearest well_ _570...Distance from foundation---- t ______.. to nearest lot line__ ..-_--_-.. Number of lines__ ____ _______________Length of each line... ?__^ __ -----Width of trench.__. ........._ Type of filter material._../?43 ___Depth of filter material___._ -`.�..._-Total length___-_.-_�{®___�________________ _ it See a Distance to nearest well_____-50-_ _ _Distance.from f undation__- P g - -- - - .��'___�-x+_.Dis ante to,nearest lots ine.... .......... Number of,pits___ ______________Lining material.- Size: Diameter _ _____Depth_ -----••- Cesspool: Distance from nearest well--------.--:`.Distance from foundation.-. ................Lining material------w......................... . ❑ Size. Diameter--------------------------------------Depth---24�'----------- •-4-------------------------Liquid Capacity. ...gals. Privy: Distance from nearest well----------- . s____________________ _______Distance from nearest building_______-_________________..__-._-_.__ Distance to nears lot line----------------- -- -- ------------- - ------•-•-----...--- - ,,(r .'N . r /� p }� Remodeling and/or repairing (dascribe):_ �'].1 .� A+�4---- ------ ---_t71 _ _"-•.--1..� _____RF� ____._ FC •,t 'Tih-S------ ------- .4`_4------------ 74ts------A_ - R .---------- ---- . _lsmp;P.P.61-_-11... '-'i Ir� # '-� R---- 4 ! .. H W At- I hereby certify that I have prepared a lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r ulati n of the an Joaquin Local Health District. (Signed) - - -------- ------ ---------------•----------------------------- --------------------------------(Owner and/or Contractor) By: --------------------------------------- •-••--------------------(Tt+le)---- --------------------- ----------- --- - - --- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY...... 1 +. .,Q_ DATE_._.--I---- REVIEWEDBY----------------------------------.------------------------------------------------------ --------------------------------- DATE------------------------------------- ---------- BUILDING PERMIT ISSUED------------_-_------------------------ - --------------------- -. DATE. ----------------------------- Alterations and/or recommendations: + , ---------------------------=•-----------_-----.._._.-------------------------------------------------- ------------------------------------------- ---------------------------------------- ----------------------------------------•---•-•----------•-....--------._--.------------------•--- ---------------------------------------------------------------.-------------------------------------------•--------•--..------ LFINAL INSP - -- - - ---- ---- --• ---- Date---------1_�----5.--6- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED a-99 2M 5.62 ATLAS