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I FOROFFICE USE: . _ {----------------------------- -------------------------- _ ` ------------------------ -----------.-------------------- APPLICATION -FOR SANITATION PERMIT Permit No. ....l......._ 9 I ---------- -------------------------------------------- (Complete in Duplicate) �{ y --------------------- --- 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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND IOCATION__ N-rI��: _----- ------• ---------------------• Z ... -----------------•--••----- Owner's Name---._.6 -M-... ------ ----- ----- one.... Address------... - 2 - 4 C------1-�-----------MAl UT,I�.-QA------------------------- Contractor's Name....OWX.9 ---- .............----------------- ---------------••----------- -----------------------------------------... Phone........I.......................... Installation will serve: Residence Apartment House ❑ Commercial Trailer Court Motel Other ❑ 11 ❑ p ❑ Number of living units.: .1--___ Number of bedrooms _x�_. Nu,ter of baths .f_.... Lot size ___._,/ __x_� - ----- Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ _Gravel Ej SandyT L� a!n Clay Loam ❑ Clay.E] Adobe❑�Herdpars ❑_ Previous Application Made:[If yes,date--------------- -..) No �ew Construction: Yes V3"'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available-within 200-feet:)-,f r � ,.��+� Septic Tank: Distance from nearest well.. ��•- Distance from foundaijon.._ .Materi$1__R=mA1 Np. of compartments___- _..____Size._- _.+ -97K.-P-__ Liquid depth--------- Capacity---- ----G`C Disposal Field: Distance from nearest well__- QDistance from foundation....1)... -____Distance to nearest lot line.-__S-�-..- Number of lines.__-_______ Width of trench _..2 �X1`�1!VC �-• ----:-- ---------Length of each .___ lines :_ ��.. &YD AbD Type of filter material._„f :g,C,f .._Depth of filter material----- _ _____Total length------- ----_---_-- Seepage Pit: Distance to nearest I well _-_________________rDistance from foundation.........___..!_._..Distance to nearest lot line,.....___-- � 1 ❑ Number of pits----------------------Lining material_--..--..-------------Size: Diametei•------------------------Depth-------------------.............. !,•.- s-.tet.�1"ti ; Cesspool: Distance from nearest`well_________�kQ________Distance from foundation__-___-_---..'.___lining material-----_............................... ❑ Size: Diameter_------ -°n `------- Dept -----------m-------•----#-- Liquid Capacity P - q ---.......--------•-••---.-.gals. Privy: Distance from nearest well _____________------------- ------------Distance from nearest building-___________--....______----.__El ` :___._- Distance to nearest aot line...............[ Remodeling and/or repairing (describe) -------------------------•---••-•------------------•-------•---•--•-------••---•----------------------------•------ - ---------------------•----••--------------------------------- ............------------------------------------ =-```' - ' -I�--'-------��--- ..._Jt' _ !_ - _ f i--------��I�:�D-W A�_, (� I hereby certify that I have prepared-this-applicafion and that the work warm tri.accordance-with San Joaquin County ordinances, Sta a laws, and rules and reg ions of the San Joaquin Local h District. , - - ,.., _ ��_. -.._ ( 9 ]-- -----(Owner-and/or--COntractofij,-' By: -----------------• = ``��` ”--'f-'-`--�,••---------- - �.. ----------------- (Plot plan, showing size of lot, location of system-in-refation-f :ells--guild igs,-etc., can-be placed-oA_reverse side). - FOR,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------_.1_:�-�= RjL-�------ ------------------------------------ -- ----------- DATE------- REVIEWED BY----------................ ... ------------••---. DATE--------------•- - - ... .--- - BUILDINGPERMIT ISSUED---•--•- -----:----------------------------------------------------------------------------------- DATE.------------------•---- Alterations and/or recomrNn ations------------------- - ------.......----------------------------------------•------------------------------.._..--••- ------------------•-•--....e.------------------------------ ----- --------------------------••-------• -------------------------------- ---------------------- --------------• ------------- --------------.._-...- -------- -- ------ --------------------------------------------------------------------------------------------------------------- -•--------- --------- K ... .. - -- ---- ------------------------ -------•-------- ------ --------------------- ------ 14 .... ------------ f I _ y FINAL INSPECTI - -------- ..-.-- Date-------- ---------- k -------k SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut 124 Sycamore Street 205 Wast 9th Street ` Stockton,California lodir California Manteca,California Tracy,California [ ' ES 9 REVISED 5-99 2M 8-41 ATLAS �,