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FOR OFFIC USY. " " l�u----------------------------- --------------------------- o.Permit N - APPLICATION FOR SANITATION PERMIT --- (Complete in Duplicate) Date Issued - - Issued . -------- ,"/' --�•�-�-.!.':� This Permit Expires 1 Year From Data Issue ----------------- Application is hereby made to the San Joaquin Local Health District for a permit to constri ct.aninstaltheo herein described. This application is made in compliance with County Ordinance No. 549. � � -------._ ........................................ JOB ADDRESS AND LOCATION f r --....... --------- Pne__.._... Owner's Name--_-- --• •• --L----•- f ._... Address.......- --- --------- --------•----------------�--------------------------------...------•-•------------ .. Phon i Con#rector's Name----------------- - -- a-- -•-----------•- - l , Motel: Other Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number baths _ __ Lot size -- --------• k Number of living units: __. Number of bedrooms _ # _ Private De th to Water Tablei. Water Supply: Public system ❑ Commuriity system ❑ P Character of soil to a "depth of 3 feet: SandQ Gravel ❑ Sand��la m ❑ Clay Loam ❑ Clay ❑710 Adobe Hardpan ❑ ..' ,45- Y New Construction: Yes [3 No [�FHA/VA: Yes ❑ No ❑-, Previous Application Made: (1f yes,, TYPE No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Matar�al _____.___ i ----•--•...••--• tic an Distance from nearest well-----------------Distance from oundation---..___-.-._-..._ . � tt No. of compartments--------- .-•---...-Size--- Liquid dep7_ ^: i� TCapau+y _.._._.cr...._ t. ` Size---- f Disposal Field: Distance from nearest well_A04V.----.Distance from foundation... ---_.-.Distance-to nearest lot;line�f ..__.... --Length of eachf lirie._, '_Q_- ••-----•Width of trench. ___ :: --•--�•••-- 1� Number of lines------- ---------- �r Type of filter material.�`�+r_ 10C-le-'Depth of filter�matenaL__„ __.,-____T•otal_length.•..................... :--------- r 1 � k / -- -- Seep�_ag/e ��ta Distance to nearest well-/ ;Distance fr , foundation.��...------.Dista ce tonearestlo�t�l'In�e,f..-�?_--_!�'" \ U "� �l P V Number of pits--..._�..----..---- Lining material Diameter___-. __ ' � ► J Cesspool: Distance from nearest well=--------------- Distance from ---------- Lining material-------..----__---. nls. ! I -----Li Liquid Capacity-------•----•--•-------•----5 : Size: Diameter---- ---- =---------------------;Depth------------------------- q P tY � j ❑ ------------------------------------------ ---.-Distance from nearest building`----------------------t.•---•••-__---" Privy: Distance from nearest well-- I .. Distance to nearest lot line. ----------••-------------------------------- ---------••-------••------ -----• •• ----•---•--1 - :m-------------- Cl ;_ ------ Remodeling and/or repairing (descrEbe)--------------------------------------------------- _----------- --------- ---------- ---•----• - ---- -- -•-- ---- - -------- ---------- - --------- -------•--------•----•----•- ( I hereby ertl y that I have prepa- r-e-d this appsIcatiom•and-that-+he-woA will-be Bona-in accordance with San Joaquin County ordinances, aws, anO r as and regulations of thecSan Joaquin Local Health District. -•- - - nor and/or Contractor) (Signed)._--- ---1; ----- l --------- ------------•------••---- ...----- A,--------------- ------------- --------- ` - ------=°----- (Ti+la)--- By: f (Plot plan, showing size of lot, la tion of sys+em i r la ion to wells, buildings etc., can be placed on reverse side). l # FOR DEP RTMENT USE;ONLY I i APPLICATION ACCEPTED BY-------_-- - ----- ------------------- ~ DATE_..__.A2 f�=n-6/-•----------- i iREV1EWED BY--.... t = ------------•--- DATE------------------------------------------------------------- ,,REVIEWED PERMIT ISSUED.. • _ -- ••--•--------•_-------- D TE Alfera+Irina and/or recommendations: --•----------------•-----------••-----•- ' - ... ----- ---- -- -- - ------------ l ; --------------------------------- •------------------------- FINAL INSPECTION BY:.. < - - -- -- - ------------------------ -------------- - --- Date-_ a -��ft --- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfinet Soo West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-99 QM 6-61 ATLAS