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_"�r^"��`^-sem•" �Yr'�^..��f.T.e --------------------------------------------------------- +Yr ----------------- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..../,;[4.�y (Complete in Duplicate) 161— --- ----------------- --------------- This Permit Ex ires 1 Year From Date Issued Date Issued .._.....�...��z- Application is hereby made to the San Joaquin Local Health District for a permit to construct nd install the work herein described. This application is made in compliance with County Ordinance No. 549. SS— Z.3b_rf�3 R J08 ADDRESS AND LOCATION_ / � N ., 1 Owner's Name.. _.� - ... ..-t_/V6LII�z -.. _-----•-----•--• Phone.... Address --------------------- -�- -�-6-- P ----------- Contractor's Name............. ..... t� +-----------------••---•------- hone. Installation will serve; Residence ❑ Apartment House Commercial ❑. Trailer{Court ❑ Mo+el ❑ Other ❑ Number of living units: __1____ Number of bedrooms `!Number of baths _.P--nCot size �--�-�-- - --•-----------••--Water' Supply.Supply: Public system ❑ Community system ❑ P�rivata�Depth to Water TableIJZI Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayX Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No( New Construction: Yes No ElFHA/VA: Yes ElNo� 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_ffv'Q----_Dist a from fou tion__ __ '5 Material... �.: ._.. No. of compartments___-_ _ -_____-.____Size. l _x5-__..Liquid depth-__.._ ' .. .Capactty._�. .... -�._ Disal Field i t nce from nearest well- W' �.�_Q-_._ _Distance from founds ion_..: . ,�._--'pistance to nearest t I' e.__^._�`�— ber of lines----3......... --_--_-- --Length of each line`X �'/_lJd � AVidth of french--- �_ ------- h Type of filter material._ --�- -- -_ - e^•a' opth�of,filtermaterlal__;P __, ____Total length_d ?'p.-__ Seepage Pit: Distance to nearest we-L_____________________Distance from foundation_-____-..___-_-___-.Distance to neare/f*? ne................ ❑ Number of pits.----------•----------Lining materialT.-T--- -------Size: Diameter------------ Cesspool: Distance from nearest well_______._. -----------Depth------------••--..........:...... ..: Distar ce from foundation...---_________----Lining material.............................. ❑ Size:-Diameter-----------•--------------------------De th------•'--------•-. p ---------------------------------Liquid Capacity--•----. ----------••-------gals. Priv .__ r v _ r-- -.-, � _ im :. ------- - -,� y � - �,;� a. y• Distance from nearest well_ __ _ ____________________ -------------Distance from nearest bum;n 'a' ` -- 9------ • C Distance to nearest lot line--------------a____ _ ---- • Remodeling and/or repairing (describe):.___. "''�C.' ------------- ... ...7 --------------------------- -------------_ ------------ ---e------------------------------------------------------------- -----••---------•-----••--•-------•--------------•------------- - ----------•------•---•-------•---------------•---------------•--•---------_----•----- ------ --•-----•-------•------------ ----------••--------------•--------•----------------:............`-...... '' -------------•-----------------------•------------•----------•----•-----••----- 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 rule ;�dr"eg/ulaonsof the San Joaquin LocaE Health District.(Signed). Y---- e... :.----------•---------------------- -----------------------------------------------(Owner and/or Contractor) By: -----# ---------•------ ---- -- -- --------------- - --- ---------_-------------------(Title)-----------------•--------- (Plot plan, showing size. of lot, location of sys+em in relation to wells, buildings, etc., can be placed on reverse side). � FOR DEPARTMENT-USE-ONLY - APPLICATION ACCEPTED BY------------------..-.-.-.-.-.-.--------------------------------- ----------------------------•----------- DATE.. <: REVIEWED BY .................... DATE------- �__�-_.._. .� a z 8iJlLDING PERMIT ISSUED ---------------•--- �" °mss -• -----------•----------_ DATE--------------•---------------------•- '�-•--P------ Alterations and/or recommendations:--------------- x,,,. , ---•---------•-•-----------•---- -------•-----------------------••---•--... -- - ---------------------•---------------•---------------- ------ ------------- -------------------------------- •--- . ----------•--- - ------- ...................................................... FINAL INSPECTION BY------------ -- Date--_--_-- ---!_ ----- / •- ---6------(L __... SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 124 Sycamore Street Stockton,California 205 West 9th Street Lodi,Californiq Manteca,California Tracy,caufcrni a E8 9 REVISED e•89 2M y-61 ATLAS �.r