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f FOR OFFICE USE: - ------------------- --- -- APPLICATION FOR SANITATION PERMIT r2� Permit No. ....�. ...._ - --------._ (Complete in Duplicate) Date Issued ....----..�. ./�' � ---------------------------------------------------- This Permit Expires 1 Year From Date Issued 0C3—t3v—o5 ' 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. W, �99 oN lz= 7v Ire!!fa�, [2---PP. -.- :, ,� etit/ �li9Y To r`is� .e of JOB ADDRESS- ------------- AND��LOCATION�_!_�. ------s �. ss _...---f __....t�� Sf.. --alt,t?F?, 1-A------------------------------•--•- l' Owner's Name...... /._ ------..deo z ry ----~-�--------•--------------- Phone !I�. _ ... Address-.................... ------------------------------........................ --•---------•---••-------------------•-•--------------------•--------•----------------------•----••-----•---. Contractors Name.. �f, �..__ �/r:F/ op--X AJ----._1 C`' Phone.//�J Q. .-• 1� Installation will serve: Residence Apartment House [j Commercial{C] .Trailer:Court ❑ "Motel ❑ Other ❑ .,� ` Number of living units: _.1___ Number of bedrooms ._3.. Number of baths..-/... 'Lot size------ .................... Water Supply: Public system [I Community system ❑' Private ET'Depth to Water Table 44P_ ft. Character of soil to a depth of 3 feet: Send ❑ Gravel F] Sandy Loam V Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {lf yes,date--------------------) No ®' New Construction: Yes ❑ No 59,-`FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) : ;.T Septic Tank: Distance from nearest well---------_-------Distance from foundation---------------------Material....--.._______.________......... .....__.._.. ❑ eXA571AOi No. of compartments------------ ------Size----------------••-•------------Liquid depth-------- ------_Capacity-----•--- Disposal Field- . Distance from nearest well.- ''___.Distance from foundation._IV......_.Distance to nearest lot line.,........ Number of lines----1----------------------------Length of each line____,7r_f------------......Width of trench._...7.`V_r.................... ' Type of filter materia !_.#_ Depth of filter material----/P-----------Total length__;"'ft..____-_•-------------- ------ See age Pit: Distance to nearest well__ ________Distance from foundation__hA:%........Distance to nearest lot line..... 14/ Number of pits----------4--------Lining material•_. .e------Size: Diameter........73- -------Depth.___.M?S--------------------- Cesspool: Distance from nearest well----------------- from foundation...-----------------Lining material----------------------------------- El Size: Diameter----•---------------------------------Depth----------------------------------------------------Liquid Capacity-------------------- gals. Privy. Distance from nearest Iwell --_-_-=____-_---------------------------------Distance from nearest building____-.__-________-----•--_-____------- � ❑ Distance to nearest lot line------_--------------------------.-----------------. ' Remodeling and/or repairing (describe:_,*4l?dD-------�----4P!2 S /111 ------- -------------------------------------•----_-•--------- ----•----------•--------------•--.-.---.-------........... -----------------------------------•----•---------••-----•----='----------•--------- ---•--------------•----------•---•----------------••------------------------•---•---------.--------------------- ------------------I-------------------------------------------- -------------------------------------•---------••---------------------------------------- {-----t---------••-------••-------------•-••------------------------•-------------------------------.•-•-------------•------------•-----------.--- 1 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 Health District. (Signed)-------- Zg:� 1.Q�AX,-V-- L4'pCY..F .-. /e ---------------------------------------------------(Owner and/or Contractor) I By:------------�� (rule) R ................_ . (Plot pian, showing size of lot, �--catfrn of system in relation to wells.I buildings, etc., can be placed on reverse side}: FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------{ _- _-_------ DATE... "�.a J� Y REVIEWEDBY------------------------------------------------------------------------ '--------------------._------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------- -------------•-•--------------------- DATE------------------••-----_--- •----------------------------- Aiterations and/or recommendations:--------------- ------------------------------- --------------->------=--------•------==----------•-•--------............-••-•---• -------------------------•--. -. -----•----------- ti ------------------•-•------------------•---------------•-•--••-----------•- -------•-----•---------••------•-----------•----------•-----•• ....... ...---- ----••----•-•-------------------------•------------------------------------------------------------- ----------------------------------------- -------•--...._.- ------------•---- ...-•--------------------------------- - ----------•-----------•- --- -------`------------•----•--------- •-•------I-------------------------• ------------------------•-------•------•-----------------------•• ....... - 1, aa ` --- ---- --------•--•---•-------- FINAL INSPECTION BY:.-41:2e4--- .-_ . .. . --•------------ Date_ 4... SAN JOAQUIN LOCAL HEALTH DISTRICT *= 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th Stroll Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 6-99 RM 5-61 ATLAS