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FOR OFFICE USE: : ".------ l�_!(�` !� APPLICATION FOR SANITATION PERMIT Permit No. ...l..l_..l. ........................................ {Complete in Duplicate) 7� E Date Issued ........f:.. .... 7i ..................................................... This Permit Expires I Year From Date Issued Z�lp u 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. MRNTFC19 JOB ADDR SS AND LOCATION /�WIT-HAM 1% I4 .......2n.> ..-I�If�......W...Q.F-..�►.�.�. �CXS...F11V..4�....5!_D� Owner's Name-.--..CORA.. VVC_R- -HAM. ................ ..__..... Phone.................. ............... .... ................ Address.................Rd------5-0)(--------7.Q—.....-•---••..........M_t9,N.Yl_C ....__........_.__M_....T.............j ................................ Contractor's Name-MaArrizo.......s E T�Cr. =L?.a N1.1.��......----- • t �v. Phone- -�- 3 . •-i Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: . Number of bedrooms .2. Number of baths .-2.- Lot!size ....1QQ.X--.- 0- ----•----------------- Water Supply: Public'system•0 Community system ❑ Private �aDepth to Wate.rJable ft. Character of soil MAI depth of 3 feet!� Sand P/Gravel ❑ SandY Loam• C�laY L m❑ Clay �Adobe CHardpan ❑. t! ' Previous Applica+ioe Made: (If yes,date....................1 No New Construction: Yes �No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATIONIAND(SPECIFICATIONS: r! jar No septic t�nk or cesspool permitted if public sewer is availaeee within MO feet.) { f � V► Jtjj�� N• ,. Septic T nk: 'Distance from nearest well..,�+...Q....Dista-K-6 ftrom f1clation...lV.... .....Material.n. �l1lQ0. ............. 6� I In No. of compartm nts...... ............Size. X� : _..Liquid depth.... ____...._.....3Capacity_f 0 o t I Disposal Field: tpistance from nee:rest well_ ..,?�'Q...Distance from foundation._...B? .....Distance to nearest lo+ line...��.... P ii ®/ Number of iines.1....../._ 'ng # ~' '�` - ..................Length of�each line:_:. �D.._....�•_:_:-Width_of.,trench._... .�.......----•-----•__-` h A 40 - a ,jType.,of filter m`ataenal....R.Q.C_/Depth/.f Iter mat erial.....Ig._.........Total length............... �.......•........._ Seepage Pit: Distance to nearest well-- 'il stance from foundation...................Distance to nearest lot line................. j Number of its..........:...........Linin material............_.....�'.Sizei Diameter........................Depth.................:..___------•-- O ❑ P• . g.. � h Cesspool: Distance from nearest well ........(Distance from foundation....................Lining material..................................... ' ❑ Size: Diameter_........:.....&. .....Depth............__...__ --•-•----.._.........-•--•-Liquid Capacity.._.......................gals., 4 ' Privy. Distance from nearest well ....................................Distance from nearest building.......................................... � ❑ Distance to nearest lot line....... ..................................... .....-------••-•----•--...........-•------•--••----..........................._......-----..... f I Remodelingand/or repairing (describe):........._................................_............................................................................................................ .•.............•---•----................_------......--••--••-•--...........--..........--••---•-•-•----....-•----............•---•-••----•---•---•---...---......-•-•----......---...........•--..................-.._... — ..................................••••-•--•-•.... .........••---•---•------...........-------------•------....---------------....---•--.._..._._....�"`--............._..-•--------•-_...... ........_.. I Ill b c rtify that I have prepared this application and that+he work will be done'in accordance with San Joaquin County, ordinances, t Imo. and rules and regulations of the San Joaquin Local Health District. (Signed). t.. -` �r�� _..................•---......................... ------- -------------------'e.................(Owner end/or Contractor) BY.•-•-----•.....................•--••..............•-•-••-•••••--••-........---•-•-••-•.._...-•---•------------------------------•----(Tifler. ................................... ....................... (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 Z APPLICATION ACCEPTED BY.........rx.R�,Q---------------------------------................................. DATE....... ............... REVIEWEDBY............................................................................................................................. DATE-•---..........................................•.......... BUILDINGPERMIT ISSUED.............................................................._..................---................. DATE--•---••----------.-------••------------------------------ Alterations arid/or-recommitnd'ations:.!-r- .................. .......................................-.................................................................................... .....; ..------••..................----------...--------------------.•........_..._......-----.......•-•---•-•• . == .......................................----.....................rte............................ ............................................---•-- = z ................................................... f •• . •-••----..._...._••-••.............. .. ---...... .......... .....i........................................... . . .... Date........... ..1. �------------------_---... FINAL INSPECT SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stroh +r 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E9 9 REVISED 8.59 2M 5.62 ATLAS