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I� ruKvi-1-It„t USE: I ---""--"---------- --------- ------------------ I ---------• APPLICATION FOR SANITATION PERMIT Permit No. ._ ------- --------••- 3------------------- (comp lets in Duplicate) .. .. T} T<his (permit Ex fres 1 Year Frosrn:Date Issued _ � �,, Date Issued Application is hereby made to the San Joaquin Loca'I Health District for a'permit to construct and install the work erel descrbed. This application is made in com liance with County Ordinance No. 549. l 'rf`I T-ZD P- JOB ADDRESS AND LOCATION...+._._- - - �! -E q� .. Owner's Name--------_ - _I n� � t��_ ------ Ph Address ----------- ------------------- one.-•--------------•--"- •- --- _R r--------••---•-•------------ ---•--•------..._--•-------- :Contractor's` Name------------Q4 il;V.P_ - R ---------•--•---E-------••-- ...................................... Phone...... Installation will serve: Residence E"partmen.f,House ❑ Commercii9E] Trailer CO-Urt ❑ Motel ❑ Other ❑ Number of living,units: -___ N ber of bedrooms _�-�--"" Number of baths ��—_ Lot size -�fJ s. ti ...................... Water Supply: Public system':ZK Community system p Private ❑ Depth To Water Table S_ ft. Character of soil to a depth of 3--fee+: Sand ravel ❑ Sandy Loam &Cle Loam Clay Ado 111111 Y ❑ Y ❑ be❑ Hardpan ❑ Previous Application Made: (If yes,date___________________} No �I. } New Construction: Yes P'No•❑ FHA/VA: Yes 2r�'No ❑ TYPE OF INSTALLATION AND'SPECIFICATIONS: :� � mak_. _ --•-� �s�-----� , � - -- � - -_ _ � - i (No septic tank or cespool'p'erm'ittd tf�pu6lic.seweris-aveileble within.200,fee#:I - ... Septic,lank: Distances omm neare t well s x (stance from foundation__: •-"""-.,.M Leri No. of compartments_ __ r-_-----•--Size_axr'o --K-Liquid depth__._j� r.,,.----Capacity. Disposal Field: Number f l'nesDistance from ear st we-I1 �1-�VFpenta+hc�e rom foundation... �__-.._.Distance to nearest lot line___ r, �• Length �ea i line_ " -:Width of trench-------3.6 j�✓ __ Type of filter material._ . V-Gam„_De th of filter material___-. � � r p Total length___..---_ --- -- Seepage Pit: 'Distance to nearest well------------------Distance from fou ndation_______z.=:....._..Distance to nearest lot line................. , !I ❑ ('Number of pits----------i.....J----Lining material-----------------------'Size: Diameter-----------------------,Depth -----••-- - Cesspool: Distance from nearest well________________ Distance from foundation__--___-_---______-Lining'materiel. ........ j. .____.___-________....__.._ ❑ Size: Diameter.---- •-------`p---- -•-••-Depth-------•------------• -----------------------------Liquid Capacity. gals. Privy: Distance from nearest weIIR______________R_____._._ : _~:._."___.___Distance from nearest buildin ❑ Distance to nearest lot line_--_ g Y - _______y_____________ __________________ =j Remodeling and/or repairing (describ�}:_ FSR � ---•------•-------•----••-------•----------------------•---- --•` ------•------------------------ - - - ` - - -A -► _ F M ' - i - --- --------: ---------------------.---------, I hereby certify that I have prepared #his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and -regula#ions of the San Joaquin Local Health District. (Signed) l ----••--------------- ----------- -----------------------------------------------------------------------(Owner and/or Contractor) BY� ------------------------------------ ---------------- ----------------------------•--------------•----------. ile-- --------------- - -------- e - -. (Plot plan, showing size of lot, location�of system in relation to wells, buildings; Mc Mean bplaced on reverse side), { . ,.•.. L FOR DEPARTMENT USE.ONLY! vi f {U, APPLICATION ACCEPTED -----------------------------•------ ------ - ----'....DATE-----, � cJr` -.----------•---- REVIEWED BY-------------------•---------- --- - ------- - ---------------------------- ----- -P- ---------" DATE-- •---- -----•---_----•--------LL• BUILDING PERMIT ISSUED.----------_-----1•---•....------------•-----------------�:----- !- ,_ - -------- AFFerations and/or recommendations:_-i:4 _ `` DATE ----•--------------- ---: ---------------------------••-=---------------------........... ---------------------------------------------------- -- - •---•---------------------- -------•------------------------------ ......... ------ , 'FINAL INSPECT( - ----- Date_------------ r... SAN.JOAQUIN.LOCAL-HEALTH DISTRICT 230 Soufh Amerlcon street ' 30QlAIes1..0ak-Strut 324 Sycamore Street ' 205 West 9th Street Stockton,California Lodi,California , Manteca,California Tracy,California ES i 9 REVISED a-59 2M 5-62 ATLAS % I � rr