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FO OFFICE USE: A. APPLICATION FOR SANITATION PERMIT Permit No. _._ --f�-- -•� 13 (Complete in Duplicate) Date Issued -- ----------- This Permit Expires_1 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 1,7..... .................................................. ... ---------------_------- JOB ADDRE55 AND LOCATION. 1 -- J `>ete -- L--ti--1-!-R--.•s�-..-•-)• -- Phone_--••�- Owner'sNome --• --•- ------------- i -- - -------------------Address------- Phone Name---------------- .� 1-� •� Installation will serve: Residence 5, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms .../-. Number of baths _!____ Lot size __________�_ a-_ x---/.Q__0................. Water Supply: Public system jq Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam�& Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No M ; New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f {No septic tank or cesspool permitteif ptufblic sewer is a y-ailabl-e-wi-t-%hin--2-00 Septic Tank: } nearest dllfeet.)" rial.. �d: .......... we -_---DDistance rofoundation-- • Mate Noof compartments i � Liquid depth__... �------------ Capacity . Dispose 7 field: Distance from nearest well___-_.�__�.._Distanca from foundation......A—) Distance to nearest lot line__••--1.` ._ __.______ Length "f each j�- Width of trench.______-_,��------------------ J Number of lines_°______________� - 9 !r De fit of filter material-____-- -- c"__-•--Total length)-.----_6,0..___•--....----••------ Type of filter material.12e,¢ - --- p IJ (// Seepage Pit: -Distance to nearest well--------------__------Distance from foundation----:_.....---------Distance to nearest lot line-------------- ❑ Number of pits..!-------------------Lining material__-------------------Size:�blameter------------------------Depth-------------_--............... Cesspool: Distance from nearest well.................Distance from founclat/61n_.__-______--.----.Lining material..-.__.____-______-----------•----••- - Liquid Capacity-----------------"----....._gals. ❑ Size: Diameter--------------------------------------Depth---0-----------------T-t- -------- ------------• Priv Distance from nearest well_______---------------------- ---�k'Y"Distance from nearest building_._______..._____.._------....----••---.•. ! y' I A -------------- Cl --- ---•--------- Distance to nearest lot line------------••----------- ---- --------•----- _ .- Remodeiing and/or repairing (describe): ---------- ____________________________________________•-_--____.....___.._ ' -----------------•-----------------------L-----------------.--- ....... ----------------------- -------------------- 3 -•--•-----------•-----------------------------_------------- f l -----------------------------------I------------------------—------------------------------------------------- ----------------" -----• --- •----- ----- -•-----------------•-----..----------_----•---••-----------•-------------------•------------' I hereby certify that I have prepared this application and that the oak wiil be done in accordance with San Joaquin County ori hances, State laws, and rules and regulations of the San Joaquin focal Health District. E Signed) ------------'-`a -� _ ----- (Owner and/or Contractor) ( I ByY• fin relation to wells, bulldin s, etc., ca{'Tit{e� '_... • -.L. . � '------ ----- I (Plot plan, showing size lot, location of systemgbe plated on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- t��U`5 DATE-•---------r a' � ..� ------------- -------------------------- -- REVIEWEDBY-------•-----------------------•----------------------------------------- ----------• --------------------------------------- DATE----------- --..--------- BUILDING PERMIT ISSUED--------------------------------- -------- ------ --- � DATE...... ----------•• l O S 5 --•- --- Alterit-sons and�or reco men ations:_a._. 1 --- �1�1...__...: := ' - -...:_ _._!n .. _ `' - 4 ` L3 t'- �- ------------1�- --- -- FINALINSPECTION BY:---------------------------------------------------------------- Date.--- ---------------•------.--_-__. ................. ---------------------•--- t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California EdSl REVISED B-99 21A 5-61 ATLAS y -