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FOROFFICE:USE; P . 4_ F --------------------------------------------------------- _________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ......... --------------------------------------------------------- (Complete in Duplicate) Date Issued --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the SanJoaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. r g� p_fib " -�'&'��C��-5', -S�i�7 rte•-S 1T` t JO ADDRESS AND LOCATIONAA74V-------!;5:-Z------7_44-e,0060, N ...-- CLD ----------- ,eQPio._ ---�1V...... Owner's Name---sT./14P,ftp. .4V1 _,A4...01� F--------------------------------- ----------------- Phonel.120_64r'/7.-'7-........ Address G �P ------------------S.7/r/✓ ----........................... 1 Contractor's Name------�� _./__04#els?.16./Y...tr:_ ...../4--.57.t........................................................... Phone..tA21.416ji7..... Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other Q Number of living units#PMENumber of bedrooms/ViliNt'Number of baths .Z-_ Lot size -__: `K................................... Water Supply: Public systemCommunity s tem [-] Private [-] Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------------_----) No []� New Construction: Yes ET"`No ❑ FHA/VA: Yes ❑ No ❑ TYPE.OF:INSTALLATION AND SPECIFICATIONS: —�— -� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest welllu_p_N_ -_-Distance from foundation.__.!F_--------Material-oOe----- -------------. No. of compartments--------- -------------Size-24_.....C2..........Liquid depth_....!Y----------------Capacity..,4*jfte...Pgoo Disposal Field: Distance from nearest well-/"."-."-Distance--from foundation---- _-..----Distance to nearest lot line-----4:- .•... Number of lines.....-___'!Z---------------------Length of each line....:___60_'_._---_-__.Width of trench------.A.54 Type of filter material..RV.G/-G.___.__.Depth of filter material------ ,6F.'_........Total length_._...rA� Seepage Pit: Distance to nearest well---------------------- from foundation__---___---•-__._..Distance to nearest lot line................. ❑ Number of pits----------------------Lining material----------.------------Size: Diameter----------------_---_Depth----.._...-----------..---------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.........................------------ ❑ Size: Diameter-------------------------------------Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________._________-_-•-..-.-_-..-.------ ❑ Distance to nearest lot line------------------------------------------------------------------------------------- ................. .. Remodellingand/or repairing (describe)-----------------------------------------------------------------------------------•--...-----....-•----------------------------------------------------- (/} -------------------------------------------------•-------------------._...---------------------------------------------------------------------------------------....--.-------•------...------------------------------------ �} I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)...... a a/c�hl_ _s. 3/,av,L'__.1 [r------------------------------------------------- _--------(Owner and/or Contractor) By:_. I�Z x ---------------------- ---- Title _----------------------------- (Plot plan, showing size of lo}, location system in relation to wells, buildings, etc., can be placed on reverse side). ` 7--� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- I--f-Kt_0---------------------------- ---------•--------------------------------- DATE----- tel- REVIEWEDBY------------------------------------------------------------------------------ ----------_---------------------------------- DATE-------------------------------- BUILDING PERMIT ISSUED-------------------------•---------- .........------•---------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations----------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------•-•----•---.------•-------•-----•---•------•-----•-----------•---------------------................----------••------•----------------- FINAL INSPECTI BY:. - _________ Date_..______ - � SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Stroh 124 Sycamore Strout 205 West 91h Strout Stockton,California Lodi,California Manteca,California Tracy,California } -o 8-59 yM 8.61 ATLAS