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FOROFFICE USE: - -------------------------------------------------------- ----------------------------- -------------------------- -----------------__----_----------------------------------------__-_--- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------------ (Complete in Duplicate) lo� Date Issued ... --------------------------------------------------------- This Permit Expires 1 Year From Date Issued ......71�_ 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. S49. JOB ADDRESS AND LOCATION---____R©ute 1_,_____Box Lathrop Celif, -- ---------------------------------- -•---••-•-- Owner's Name------------U-49---P&---BAa---- '`uIAaA dam-a------------------------------------------.-.---------------------------- Phone._ T.9__ T''3_03,3 Address------VF4.___QQr11e.r-_Q_�_.Jai 1`_QP...Rd...._and_. 3 dp�� ZaYs LI thz' P, CO-11.f. Contractor's Name----------------Delta..13_eP&1C---T0.T1}i---AAry,q-.j----ixwx........................................... Phone- UQ-4----3'-"-"12.6 ---- Installation will serve: Residence :FL] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ Number of living units: -- --_ Number of bedrooms ---Z_ Number of baths __- -_ Lot size ...3./ _._h1:Cz.'.e.................................. Water Supply: Public system ❑ Community system ❑ Private E] Depth to Water Tablel()-__- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Z Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [3 New Construction: Yes P No ❑ FHANA: Yes ❑ No 91 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-----------------Distance from foundation....................Material___-------_------_-_-------.__-__----------.---.- Exiging No. of compartments- ------------t---Size--------------------------------Liquid depth--------------------------Capacity.................epptth--•-----------------------Capacity----_........... Disposal Field: Distance from nearest well__ Distance from foundation /6_.-- - Distance to nearest lot Exi, img Number of lines--------- ------- ---Length of each liAN _- f Width of trench:- '�---- --_ Type of filter material.-. p f f------- . - -_-- __- --Depth of filter material------ length_--- v S`O �� See P Distance to nearest L -.-_--�rlJ.istance rdm oun fa i It_ istano�nrest i e _-._-._- Number of its-_..-- --_---- �� SI, iar�ie-ter -- -----_..De t� p 9 m e - p Cesspool: Distance from nearest well-----------------Distance from foundation-----------------_--Lining material-------------------------_-.......... ❑ Size: Diameter------------•-------------------------Depth----------------------------------------------------Liquid Capacity -----•-- ---•--•--------_.gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--_-------_---_-_-------_.------........ . ❑ Distance to nearest lot line-- -------------------- ----------------------------------------------------•---•------•--------------------------- -------•----•--•----- Remodeling and/or repairing (describe):----- --------------•------------------•-- ------------------•------------•--------•--------------•-----••--------------------------------------------------------------........--................................................. 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 rules and regulations of the San Joaquin Local Heal+ istrict. (Signed) ... . 'g! TrQAw ---- ---------------------------------(Owner and/or Contractor) BY:-----kerry...Q....�F `#k (Title)....Pres._-Gen,-Mgr. _..- (Plot plan, showing size of lot, location in relati wells, uildings, etc., can be`placed on-reverse side). FOR DEPARTMENT USE ONL APPLICATION ACCEPTED BY---------------------- --------------------------------------------- a -- DATE--------- 07-o -4 ... - REVIEWEDBY------------------------------------------------------------------------------------------------------• -------••---•....... DATE--------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-.-.----_-----• ------------------------------•------------ Alterations and/or recommendations:--.--------------- ----------------------------- ----••--•-----f------------------ -------•----------•/----------- -•---------.------------------------------------- -------------�� A --------�f)----- -ION&----y---6-------------•14. .. � ._A. .�1 c ---- -�----- 1�.-�n!r fir- ------6'�-4 AM:-;--'----------- -----•----•------------------------•--•-- - ------ -- ----------------------------------------.-.-------•--.-..-..------------..... --------------------------------------------------- --------------------------------------• ....... FINAL INSPECTION-34• =" �= 'SAX— --------- Date- 7&_X SAN ate !!_ `X SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Street 124 Sycamore Street 305 west 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-99 2M S-fit ATLAS