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OFFICE USE: ./.1-7 ------------- -------..- -----------------------.. _ .I APPE_ICATI N FOR SANITATION PERMIT Permit No. __..�/Zo .. -----------------••------ ------------- --------- ---- (Complete in Duplicate) .................. This Permit Expires 1 Year From Date Issued Date Issued ....................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descritaed. This application is made in compliance with County Ordinance No. 549. Z -070-f/ 1J B ADDRESS-AND LOCATION---�0,.0L' Owner's Name.-------- ,... ---------FU.� e �. --------------------------------------------------------------------------------- ------ Phone.—W.:--3—3- 7M.(1-- Address.......FT: -`= .bo ------li1---4..1..----•------M-tq—tv!!}-------------------------•-----------------------•-•-----------••--------------- Contractor's Name---------•Q_W- JER.--.......................................-............................--•-------------------------------- Phone................................... Installation will serve: Residence 8 partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of liven units: .._ . Number of bedrooms ._ Number of baths Lot sae _. Water Supply. Public system ❑ Community system 2--Private ❑ Depth to Water Table Character of soil to a depth of, f 3 feet: {sand I-] Gravel ❑# Sandy Loam [�Iay Loam ❑ Clay-[]—Adabe;❑VHard n_❑ - '. �� Previous"Application'Made: 7/6 [If yes,date. No New Constructinn: Yes �o ❑ FHA/�fA: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r, �y+. [No septic tank or cesspool permitted if publicsewer is a a1Y[able within 200 feet.) Septic T k: Distance from nearest well...5.Q.... Distance from foundation_--_l0--------MatariaLAl. NCRI-r4 .. ........................ No. of compartments-.-.-"-U-..........Size- Liquid depth----- .- -------------Capacity._/0.00_... 1 Disposal Distance from nearest well---�----Distance from foundation____Za........Distance to nearest lot line------ L�J Number of lines---------- 1---_--------Length of each line----M4--`J./:q7Width of,firench---------3L�----------------- Type of filter mate riaLII,I"N,_-Depth of filter material----/__ ____t__<_______Total length......... �-._.._..----------- _ Seepage Pit: Distance to nearest well----------------------Distance from foundation..............__....Distance to nearest lot line----------------- l� El of pits----------------------Lining material----------------------.Size: Diameter..................... --------- N Cesspool: Distance from nearest well................ Distance from foundation--------------------Lining material---------_.-_------.-___.-_-.-----_-- w ; ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. I� Privy: Distance from nearest well----------------------------------------- ------Distance from nearest buildin ----------._.--.-_-_...____._....------.-- 1 ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------- --••----•-------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------=------------------••-----------: ............................................. ...........................--------------------------------------------------------....------------------------------------------------------------------------�*":.#�--------•---------------------------------- -------------------=-----------------------------------------------------------------------------------------------------------------_---------------•--•------ ---------=•=------•-•--------------••------....------.- ti -----------------------------•__---_.----------------._.._......_...-------- -..-.--..._....._..... --------------- 0 '� F �f _-_- __________________ ___ ______________________________________________•_._-_-...-.._----_---____---------.----.- 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'Heaith`Disfricf:"" " , _ I` Si ned :_ - :-tl=�A �--- T � ---!'---_Owner and or Contractor ----------------------------- Plot plan, showing size of lot, location of system in relat {Title):__._._. By:-------------------- -- ------- ------------ --------- ion to wells, build ------------------- ------------------=------------ -- ----------- --- ( p g y logs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------------ APPLICATION ACCEPTED BY---- ----------------- ---------•-------------------------=------------- DATE----- _" ,�-''- REVIEWEDBY--------------------- • • ----------------------- DATE-------------------------------------------------- "----- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------•----•---••---- ---------------.------ Alterations.and/or-recommend'ations:===-.-----_=-__ —..................-----=--=- -------------------VM'----!--------=e--==--.*.=--_----------.......-_-......--------------- ------------ ------ ------- ----- ------ , +�" •! -._ .: Rs._. -, �- RF ---•..........................•-•--- -W W li I♦ IV . I j 1, v k .r ry r Iry 4%�� --- FINAL I PECTIO - --- --,_ Date--------- ------ -.- SAN JOAQUIN LOCAL HEALTH DISTRI 130 South American Street 300 West Oak Slrtst 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B•59 eM 6-61 ATLAS