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FOR OFFICE USE: -------------- --- ----------- ------------------------- /S_317 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No- _-----_1------------ ----------------------------------------------------- --------_--------------------------------------------------------------------- (Complete in Duplicate) l7—(A _------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued l_ .__....___._.._ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wok herein described. This application is made in compliance with County Ordinance No. 549. ` 7 1497"-I`i-ROr r �,[ JOB ADDRESS AND LOCATION �C,oU-�S ----•--•` ---�----.p F RK]V.. Ca. Owner's Name-------------�.....JR.-�--------�le - -q-�------- ----------- Phone----------------------------------- Address........ -------------------------------•--Address.------. ----- qq..._.. -1 T -} O +,:.... -------------------------------------- Contractor's Name----RO-TO......Q.Q_ `----•-- ----- � ---- Phone............................. - ---••----•-••----•---....----•--�-------•-••------------- ._:.._ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other C]I Number of living units: __ ----- Number of bedrooms __*L-__ Number f baths j__£4Lot.size -__ d ----z0--®--__--_____•-____--_ r Water Supply: Public system ElCommunity system El Private Depth TO Water Table --9_ ft. 1 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 ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well---- L�---Distance from foundation---- --------Ma erial_ p_N - ......... 1711 No. of compartments__.__-�,r --_----.____Size_S�_ QX.t5.iquid depth_.. ___-------------capacity... 4._... id , f 4r Disposal Meld: Distance from nearest well_______Distance from foundation.______-l _._.Distance to nearest lot ." t Number of lines_ :____--2______________________Length of each line------%5W..�__7d_.Width of trench------- ............... -.Type of filter material.-RUCK-__.__Depth of filter material_____jg__'c`----Total length----------10 ____ _______________ -��^_ Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------...Distance to nearest lot line___________.__... V' ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------.-------_---- Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------.Lining material---------------...................... ❑ Size: Diameter---------------------------- --------Dept h--------------------------=-------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-___________________________ ____________ _______Distance fromilnearest building.____..._________________-___________.._. ❑ Distance to nearest lot line--------------------------------------------------------_--_-....... ----------------------------------•-----------•--.--•---•-•-------- f Remodeling and/or repairing (descr&):------------------------------------------------------------------------------, -I.....I----------------------------------•----------•--------------- ------------•--------------------------------•--------------------------------•-••-------•--- •----------...---..........---------------------- ------- i. ....— , r�, . . --------------------••----------•-•------------------------------- •------•----------------------------------•---------------------------------------------•-------------------•------------••-•----------_-------------------------•-----•---------------••------------------------------------ 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, an rul and regulations f the San Joaquin Local Health District. (Signed)-------------------------- - '- - ----- -------------- --- -- --- --------------------------------------{ ,Gor Contractorl t - ( __Title , (Plot plan, showing size of lot, location of system i lation to wells, buildings; etc., can be place od� n reverse side). FOR DEPARTMENT USE ONLY (A APPLICATION ACCEPTED BY___-7 s ------------------------ ------------------ ----------•--------•--- DATE------•!__---.�A--- i6------�---------- ------------ REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE-------------------.:_.----------- ------------------- BUILDING PERMIT ISSUED------------- ......... ------------------------------`-----•=---------•---- DATE---------------------------------------- ------------------- Alterations and/or recommendation$':------------------ ---- ---------- ----------------........................................•--.......-----..............--------------••--•-----••--------•--- -------•---•---•--••-•---------•---•---•------------•------------•---------------------------------------------------------------------------------------------------------••---•--•---------------------------------•-•------ •-•--•------------------ -----------------------------------------------------------------------------------------------------------------•----------------------------------------------------- --... -------------------- FINAL INSP N B -- ---- Date---------- ---------------- --------- SAN -- ---SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REV15E0 8.59 2M 5-62 ATLAS { /fey