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i. ' --- -------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. ...,l.,T�7 --------------------- ----------------------------------- (Complete in Duplicate[ - -------------------- ----------------- This Permit Expires 1 Year From Date Issued Date Issued _70:416--Z, Application Application is hereby made to the San Joaquin Local Health District for, V.,P a permit.to const uta;an2d install the work herein described. This application is made-in compliance with County Ordinance No. 549. . ,_S� JOB ADDRESS AND LOCATIO _ N----_ 1 ' Owner s Name - _ --- ......FARMN•--••----• . Address - QHS lQ __ �. . `S. .._...--- --- s--t r � -;2-q-5 — 0E-D -O ------------- j #Contractor s-Name.-Ar+0.Vt � .-- ....... -------------------------------------------------------- ""'--„�.--. ..--Phone.... .........L. Installation will serve: Resider Apartment House.[]. Commerciaf ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._i,_;,Number of bedrooms Number baths I_.___ Lot size ___�1��-- I�L .. 1< _ Water Supply: Public system ❑ 'Community system ❑ Private Depth to Water Table i� ft. Character of soil to a de th of 3 feet�'Sancl Gravel Sand Loom Clay Loam � pA 0 :. -yam.��...��y_._ y,� Adobe❑ Hardpan ❑ Previous Application Made. (if yes,date�.__ � s 0' "o E _ _ _ } No, �ew Construction: Yes Na - -�-..-- _ _ ❑ FHA/VA: Yes ❑ No 'TYPE OF INSTALLATION AND SPECIFICATIONS: — - (No septic tank or cesspool permitted 4f..1public Xs available within 200 feet.) Septic Tank: Distance from nearest well_ _____________61tan8e from foundation._.____.:__.__-.___.Material__-____...____._.___........_:........._......... No. of compartments `....!Size-----------------------------=--.Liquid depth---------------- ---------Capacity Disposal Field: Distance from nearest well--_4�s Distance from foundation.___1Q__..-____Distance to nearest lot li eJ��_-,.:. 41. 'At> il—ri 0 � Number of lines-A_--/_________________V'Les gth of each line---- �6Width of trench.___.... ----•- } - Type of filter material._ROC^-------tDopth�of filter material..___ -----------Total length___________________•5 ........ e Seepage Pit: Distance to nearest well-------------- from foundation.....---------------Distance to nearest lot line__...____----_:.- ❑ Number of pits___ _____.____--____Lining material-----------------------Size: Diameter_--.-_----- } f -•----------Depth-------•------••------------•--- Cesspool:••-•• —Distance•.fro m.,.nearest;rveil:_:.:__:–•---.Distance from foundation_________....._._,Liningiaterial_..__-.___..____ t p ❑ Size: Diameter Depth Li uid Ca aci Priv S1 it-*.At q P tY----------------=_------•----gals. Privy: Distance from nearest welt______________._ • - ._._Distance-from• nearest buiiL -• 1 I Distance to nearest lot line------ _- 9 -----• ----#---------- Remodeling and/or repairing (describe):-------------------- -------------------------------------- ------- ----•-------•-••-------••------- --------------••-•-•----- ..............• ------------.............-----------------•----------• -• -- ------•-------•------------•------- --------- ---•----- -- ` -----•I•-----------•------------••1 -........ --- --• •- ----_-------•------------•-----------------•-- } t--.... State laws,.:and rules and re this as li the_San Joaquin Local w -- -- -- •---•Sa -- Ihereby certify +oaf I have pre orad this application a`d that the work will be done in accordance with San Joaquin County ' ordinances, g alth District. Si ned ._:_ �-r I ---------- -_ {Owner and/_oc Contractor)_ BY:--------------. �-- Title - = ••------------------- (Plot plan, showing siz0 of lot, location of system in relation to welli, buildings, efc., can be placed on reverse-side). f �€4" A+ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ 7T!_R,Q` ----' -___:--_--------.--- ----- "_� �- DATE_...__ REVIEWED BY__._... '------------------------ --------- DATE BUILDING PERMIT ISSUED------_-------#-----•----------------- .._ ._ Alterations and/or recommendations__________ -------- --------- ____________________----- -- r ..--------------- --------------------------------- d -------------•-......................-------•---•--- ----••---- -•------------•----------------------••----- —•....... ........................ .. •--- --------- ----- I FINAL INSPECT - Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California Manteca,California 205 West 91h Strut E8 9 RE VlS po 8-99 EM 5-61 ATLAS Tracy,California I