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FOR OFFICE USE: `' I -------- - --------------- ��- APPLICATION FOR SANITATION PERMIT Permit No. ........................ ------, '--.----_--- - �- (Complete in Duplicate) �f -�� " Y ��--------- 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. JOB ADDRESS AND LOCATION.........1/&Z------- --------1 --------------------------------------------•-•------------------- —67024 Owner's Name GIsS-------•---------------------------------- -----------------------••-------------- Phone._ 7...... Address.......-.Z597,-..1........... t Contractor's Name... ....szweS. IS....__�/1 c--------------------------------- Phonehl 9:6-_0,6.Q.-_7 Installation will server Residence. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._1.... Number of bedrooms _____ Number of baths .-/__- Lot size ......X._._./ ............ Water Supply: Public system 0 Community system 0 Private Depth to ' Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobef!f`�Hardpan ❑ Previous Application Made: (1f yes,date--------------------) No New Construction: Yes ❑ No IEI� FHA/VA: Yes ❑ No ❑ 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--------------------Material.------------------------........................ ❑ CL57ING No. of compartments-•-•----------------------Size--------------------------------Liquid depth--------------------------Capacity....................... Disposal Field: Distance from nearest well------------------Distance from foundation--__________.....__.Distance to nearest lot line................. ❑ XIdTlty� Number of lines- ---------------------------------Length of each line------------------------------Width of trench-----------------..----------..---- Type of filter material-________________________Depth of filter material.-------------------..Total length--------------------------------- Seepage ____....__.____-_-___-_._______Seepage Pit: Distance to nearest well__ID-Q.-'------Distance from foundation-----3_02___.Distance to nearest lot line----- ® rjof. Number of pits--#-----f1.____------Lining material.---?Q -----Size: Diameter_.-_..__'..__-_Depth-------./.-tS_ ...... 1 # Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material..--------------------------......... t ❑ Size: Diameter.- -----------Depth----•---------------- ----------------------------Liquid Capacity------------_------------gals. kIe arest well 9 i ❑ r ' Distance to nearest lot line--------- --------r------------------------------------------•-------------.....-------------------------------.....---------......--•-------- Remodeling and/or repairing (descr(iiiibe):___--- 09dW-------7-0-----..!�E7XA.SJ-/.110?......X,f��7_4-�A#W---t--' l r 1 ------------------------------------ -•----------:-------------------- --------------------------------------•..........................---------------------------- I hereby certify that I have prepared this application 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. (Signed)---------------�,----- -- '---��}_. ,_kx -- .X10tl1,- —4.00C------------------------------------------------- (Owner and/or Contractor) • --�- By: {rtlel - T' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).- FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY----- - ---------- '---------------------------------------------------- DATE....- q..---I---Z_------------------•--.... REVIEWEDBY------------------------------------------------------------------- ------------•-- ------------------------------------• DATE---------------------------------------------------------- •• BUILDING PERMIT ISSUED---------------- ------------=---------- - --------------- -------------;---------•-- DATE--------....------------------------------------------------ Alteratio a d/or recommendations:__ �_ �-- -- r 1 n �� F " ' = s------- ------- ----_------•---.. r _...... _ • -----------------•------------•-------------------------------------------------••---------- i i - --•-------•--------------------------•----------------•----------•---•----------------- --------•-•- -----------•---------•-------------•-------------- --- t-------- ---------------. j FINAL INSPECTION BY:.------�' 4�-------------------------------- Date_..- 'l3�{v SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ED 9 REVISED 8-99 RM 5-9%1 ATLAS Y