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FOR OFF1 U E: !y.. _ _�_� 1- -J Permit No. _ ... �... . _ -_ APPLICATION FOR SANITATION PERMIT / � --- (Complete in Duplicate) --------- - Date Issued ............. ,...... - ------------------------------------------------------- This Permit Expires l 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. 1 ' k. . y JOB ADDRESS AND LOCATION _J�-------- #4IlPair-L/--------------------------•-------------•--•------•------ Owner's Name----•_�?e..OK:I'miec.......... '! _7"`/. ----------- �C. -------------------------------------------- Phone./,t`d= Address..................� k.A.- ...Ale., �---------------•--------------------•-•----------------------------------•-•-------------•----•-----------••----------•------••- ....... Contrac#or`s Name - ` .�..12x...�f� �!IR' /-c�% _.. P -rlo& 141a---------------------- Phone.". P. © .ra. Installation will serve: Residence [Apartment House [I Commercial ❑ Trailer Court E] Motel ❑ Other ❑ � Number of living units: __I_-_ Number of bedrooms .%' Number of baths /..... Lot size ___�'Sid________ _____ '-_.---..---------- Water Supply: Public system ❑ Community system ❑ Private 0'Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E] Gravel F] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[]�Hardpan E]i Previous Application Made: {If yes,date._____---_--.___-I No ®' New Construction: Yes [I No FHA/VA: Yes C] No [3 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___--------------Distance from foundation___—/4..'_..___.Material--- ..-- l.I� ' --••----• 11 No. of compartments-------9-_----------_Size-------------------------------Liquid depjh---0-de�--------------Capacity....4:r?9-C?- 0. Disposal Field: t Distance from nearest well-----------------Distance from foundation..__l--Q-- ------Distance to nearest lot line._--_4 �.... Number of lines--------_--/---------------------Length of each line------•-rK...--•-••-,y--.Width oftrench-----._-��K_'_w............. Type.of filter material____ ------- of filter material..... ,�-----------Total length-------------- _.--------------•• Seepage Pit: Distance to nearest well----i11`__*-------Distance from foundation__...!7;>y-....Distance to nearest lot line____J._._!..... V' ` Number of pits-------4-----------Lining material....% G'C`/C---Size: Diameter______.. d"_`.--.Depth._.-----ZO`-------------- Cesspool: Distance from nearest well..__.•-----------Distance from foundation--------------------Lining material------------.______________:-__---___ ` Size: Diamater--------------------------------•-----Depth---------------------•- Liquid Ca aci gals. ❑ q P ty;--•- ------------ - Privy: Distance from nearest well----------_----------------.------------- -------Distance from nearest building_______--_..________-_____._-.-----------. ❑ .. Distance to nearest lot line_________________________________ __ --------------------- - Remodeling and/or repairing r.� C �. , ? J; --••--••---- --------••-------------------- I _... .. ---------- { --------------------•-•--------•--------••--------••--- -------•---------- -----•--------••--------•----------•--•-----------------------•---•--------------------------------••-------•--•-•------------------ r� t. _ hereby certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County 4 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------Z000 --------------------------------------------•- {Owner and/or Contractor) i Title (Plof plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -----------•---------- --- -. DATE---------- r_�q" ----------------------- _ . ._ ---- DATE•----------•----------------------------------•--•------•- REVIEWED BY--------------------------------------------------------------------------------------- - BUILDING PERMIT ISSUED-----_---------_-------- ----------------------------------------- DATE `.._ - ----- 1 •- tom, ..--------�--- --- Alterations and/or recommendations:__-__I�__- =�'- '"�'�'---=•�� f� `� ' _� s ----------------- -------------- -----------------•-•-------•-------------------- --------- ------------------------------ ` •---•----------•--------•------------------------•------ ----------•---------------- ----------------------------------------- --------------------------------------------------------------•-------- FINAL- INSPECTION BY-A/. ------- Date_ I� f - -----------------•----= SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak STreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISEO B-59 7M 5-61 ATLAS