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rc�KUFrIC:t USE: --------------------------------------------------------- ` / -APPLICATION FOR SANITATION PERMIT Permit No. .,l. / ----------------------------- ---------------• ---------- (Complete in Duplicate) ---------------- This Permit Ex ices 1 Year From Date;Issued Date Issued .-- Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. "Ri JOB ADDRESS ANDTTION......-_____ 2 --f•�-�---------•-------••............. Owner's Name - - L?.�. f•»A ��--_------ ----- - Phone. .��.5.�.. Address , 14� -------------------- -----------------------• ----•---••-•---••----... --- .....------•-•------•-•. •-----. •--...---...-•---...... Contractor's Name-------------- .t1.P. -----•---•---------------•----...------......-------•--•-••-------------•-•••----._...._.....-----•--- Phone............ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 / Number of living units: ....... Number of bedrooms -3. Number of baths __L___ Lot size ..__.. �r__�� _y . ......_.___ Water Supply: Public system [-1Community system❑—PFivefF -`DepthTo Wetter Tablelk0t. Character of soil to a depth of 3 feet: I Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe'�°'t Hardpan [jQ Previous Application Made: {If yes,date--------------------) NoNew Construction: Yes d NoA FHA/VA: Yes ❑ NoV TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well-150-:t-Distance from-l-oundation---- I Materltl No. of compartments.. __` .Size__ .� •- .-_--Liquid depth __-_-____Ca Capacity -P2-r ri � Disposal Field: Distance from nearest well.j ._ -.Distance from foundation--'50 ...._.Distance to nearest lot line-__lpA.t Number of lines............. _ _ 9 -_ __--,_ Len fh`°of each line_______ �` �t •, .,5 _ J1 Width of trench . Type of filter matenal..�� j'j"d�K_Depth'of filter materia ----------- length----------02l3__f Seepage Pit: Distance to nearest;well-_____UU_______________-Distance.from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining matehalV31—_,,=-_..____-__.Size: Diameter---......-----------•Depth__._....-•----•--........----- --- s \ Cesspool: Distance from nearest well----------------- foundation-_-.____.._...=.___.Lining material------------------------------------- Size: 7- El Diameter.--------�_-_-_------ -De th----t-------------- -------Y---Liquid Capacity V I Privy: Distance from nearest well-------------____________ Distance from riearesfi building----------•----------------------------.-, ❑ 1"'7 Distance to nearest lot line. __` '.- -. I ------------- -- - -• --••--- i %_ Remodeling and/or repairing describel(--------------- ---1E- --- ------�.P _rpB_tin,,,r.......�] :... ed-f: �_s- _e �r �( i_.l� _ - - ---------------- r r _ , .�f-� -------------- 1 hereby certify that I have pre ared this applicatiohand-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) __`.. (Owner and/or Contractor] By:........................................................ --••-•-------------------------- •.....-----------------------.......... (Title)-------------------------------------------- ..------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can bei placed on reverse side). ,' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________________ _ ._.. , . ---- f—DATE-------°----CT - REVIEWED BY... ------------------------AJ --- -- ------------- ......../_----------------------- DATE__ ,. .� BLIILDIG PERMIT ISSUED....... --------------------------------------------------------------------------------------------- DATE. T'- ------------------ � t hPrations an /of recommendations:-•-•-------------------- -- --------- ..� v- � � --•------------ --------------------------------•-••----•----------- ............. --------------------------------------- -----------.............----------------------------------------------------- •.----------------------------------------------------------------------•--.------------------------------ •---------------••------- . ••------------------------------------------------------•---------------------------------------------------------•------••---------------------------- -----------------------------------------------------------..-...__ FINAL INSPECTION BY:._")<-..___ Date---SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Simm 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-89 $M 6-61 ATLAS