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IvmvrrK E: VJC: - ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. 13.1� --------------------------------------------•---------- (Complete in Duplicate) --------------------------------------------------------- This Permit Ex fres 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 he workhereZdescribed. This application is mad in compliance with County Ord*+ er�c {No. 549. WOwBeAsDNamse_._AN�OCA l --•-- • --�-- ---••--- ---••---or r�R `r s �. - -- -- ----- V • ------ Phone.........................-•-------- Address -�� &....... ••• -b----�--- ------------------------------------------� ---------....................................................... Contractor's Name__,J �/:=--1-+- R_ l � i ------•----- ---•--•._-•----••............ Phone-------•-••............. ••�•----- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other j� 00L_ Number of living units: -------- Number of bedrooms Number of baths ...... Lot size /7C __,,,,,-___ Water Supply: Public system E] Community system [-] Private �epth to Water Table/�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam Clay Loa;El lay [-IAdobe❑ Hardpan ❑ I 3 TYPE OF NSTALLATIONPrevious Application ade.AND SPECIFICATIONS: ' No New Construction: Yes' No E) FHA/VA: Yes ❑ No -(No-septic-tank or cesspool permitted if public sewer is available within 200 leaf.) w...,..� Septic Tank: Distance from nearest well_________________Distance from foundation---AV---------- Material_____.____.______.___....__.__................. No. of compartments---------------- q�'" Disposal Field: Distance from nearest well. --_--.,D+istance from foundation.- - depth__.._____________________ar aci Li ui i .____.._Distance to nearest lot A}ID,)P7CW Number of lines__-•------/- --------------Length of each line_.--,f,Q.Q_ !t Width of trench.----- T e of filter material... DG �.......... YP _--Depth of filter material------� j_--------Total length..........L:�Jgp----- ---- Seepage Pit: Distance to nearest well----------------------Distance from foundation____________________Distance to nearest lot line--_____.___-_•--_ I ,r ❑ Number of pits---------••----------Lining material---------------------Aize:Diameter_.._...----••-----••---Depth----- --...__ • ----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------- ❑ Size: Diameter-----i--------------- ----------------Depth------------------ ----------------------Liquid Calpacity-- •-----------......_gals. Privy: Distance from nearest well__________________ _______________-_-__.____..+Dig •�stance from nearest building ------ •------ ❑ Distancetonrest,-Iot line -------•------------•---------------------- -------•-- Remodeling and/or repairing (describe_{;__+._- --------•--------- --------------•------------------- --------------•- k' - ---••— ---•---•----- Fir 4 .x_PP �I�+tv .-. I hereby certify that I have prepared this a licatiort and that the work will be done in accordancewith Sen'�Joaquin County ordinances, State laws,Iand rules and regulations of'he San Joaquin Local Health District. (Signed) -.' sx1� 1 `Qt �r.: T 14,1V ►d-------------- -•---------=---=-------------- { • - 4nor and/or Contractor) BY_-•------------------ -----•• ------- _ — _ ---••-------- _ {Title).. ... ( P 9 'R _ Y. _..f � .- Pot�len; showin sis of lot locationiof s stem in reiation,to wells;buil kings, etc., cart be placed on reverse side). 'FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___________ __ T,1} _-. ---'------------------------------------•---------------------- DATE------- REVIEWED BY------------------------------------------------ _-- - DATE---------------------PERMIT ISSUED_________________I ------------- -------------- --------------- ---------------------------- •-----------. -------------------- AlterationsDATE -------------•---------..------ and/or recommendations:------ -•_--- ,-----_ =r ----....,. _ _ -4"" "!x __..... ...................----------- ••---- ......................... ..------------- - `�-------"`' ---- - ---- ------------ ------ ----- FINAL INSPECTION Date . _':. __" f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sind 114 Sycamore Street 265 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 0•94 @M 5-61 ATLAS