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FOR OFFICE SE: / ; � '� � APPLICATION FOR SANITATION PERMIT Permit No. ._�.7._. ----�1----------------------------------- _ (Complete in Duplicate) Date Issued S Z:S -2- This Permit Expires 1 Year From 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. I JOB ADDRESS AND LOCATION------r7 ------+-'rlQ�Y -., J! tv ----------------•--- -----------___..........-----------------••-----._.-..:... Owner's Name....�11Q�r-.....cy_�-V/7..........U�E'.C/�yr�-----_-----------_- h- - Pone - ` Q Address----------- . f �4lw------------------, ei�ci-�4i✓ � . . -- ---- •---•-__- Contractor's I Name-----..D�l�- �� 1 L• lf.-- d�.?----------------------------------...................................... Phone----------------------------------- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms • --- Number of baths J_ Lot size .-_S.o I x .............................. 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 a Hardpan ❑ Previous Application Made: (If yes,date--------------------) No X New Construction: Yes ❑ No ®° FHA/VA: Yes ❑ Nod TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan, _ Distance from nearest well-----------------Distance from foundation--------------------Material--------.------._-.---_-_------------------....- ❑ No. of compartments---------•-------------_Size--------------------------------Liquid,dep.th--------------------------capacity....................... 1 Disposal Field: Distance from nearest well---s$V-----Distance from foundation..../Q----------Distance,to nearest lot line.....__..__ Number of lines----.-----/--------- --------- --Length of each line--------4D- ----------Width of trench-----.-Al,---_----------- � � Type of filter material -- -- �Depth of filter material.....- --�r-----Total length----------- Q__••-•---•--------------- Seepage Pi _ "Distance to nearest well----Iit-V-r.--.--Distance from foundation--..1--------------Distance to nearest lot ...... ❑ Nurni er of pits.-.-----/------------Lining material......�� ..Size: Diameter.-.......? --......Depth_-.-----�-.---.I........ .. 6ua"'t t I —_ -- - Cesspool: - -Cesspool: Distance from nearest well----------------Distance from foundation-_..---------------.Lining material------------------------------------- El -.---------.--.-.------.---_-------. q� ❑ Size: Diameter ------------Depth------..-...---- I ------------------Liquid Capacity ----------------gals. �( Privy: Distance from nearest well----------------- ------- ------------- ----Distance=from nearest building------------------------------------------ F1Distance to nearest lot line----------------- r- :---- - — --- � -- -- "" ^"""` I I � Remodeling and/or repairing (describe j --------------------------------------- -------------------------------------------------------- \ ; -•--------------------------••--•---------------------•-••------------------------•-•--------------------•--------------------------------------------------------•-••--•--•••--:- --------------------•--- ----------------------------------------------------------- ----------•-------- ti..------------------- ------------------------------------------------------------------------•----------------------------------- ----------------------------------- ---------------•-------•-------------�- --•-•--—---------------------•-•----------t----------------------------------------...................................-------------------- I hereby certify that 164 prepared this ap%plication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. II � t 3 (Signed)........c;::9k Z -----------'------------------- --------•------------------Ower and/or Contractor( By:......... -` ----•------------{Title).... (Plot plan, showing size of lot, I cb ation of system in relation to wells`, buildings, etc., can be placed on reverse side). 4 OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._- /�....�_.. DATE :. .a:. ?. ,�_------ - REVIEWEDBY---------------------------- --------------------------------------------------....----------......------------ DATE-------•..----------------------•------..------------------- ` BUILDING PERMIT ISSUED------------------------------------------- ------=--------------------------------------------------- DATE•--------------•-------- ----------- Alterations and/or recommendations:---- =- - ---G --------1-- - ..? 4 -=---- F - -`'` ..- - -- ``" - i ----------•-- -------------------------------------------------------------------------------------------------•........ ----------------------=---------------••------ ---------------------•-----...-------------------------..-------------- i FINAL-INSPECTION BY:.... .... .. ----- ---�------------- date--- - --•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT; -11 k t= 130 South American Street 300 West Oak Strout 124 Sycamore Street 205 Wed 91h Street Stockton,California Lodi,California Manteca,Califorrila Traey,California ES 9 REVISED 8•99 9M 6-6[ ATLAS r � /