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FOR OFFICE SE: ______________________ __ -----------.._----------------- APPLICATION FOR SANITATION PERMIT Permit No. 13 ---- ----------- ---------------- -------------------- --- (Complete in Duplicafe) q ... .._ _Y _ _ Date.Issued'.Z� This Permit Ex ires 1 Year From 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. ®3 Ce 1pool'"S'_ crc °i J08`ADDRESS AND LOCATION: j�/ ',�3y�?, .__1A-4co ,f'_-- --- "---/ ----- '<--� •-.mf,�i�lF '►x...11 !. ' Owner's Name•• X,F_7 •-sTeo!W..AV...... - -------------- Phone/r .sef-_410F/._... Address T.-•".!/ � '••- f ----------------------tS'Z�e.e lw...------------= :...-:--::• = .............................. Contractor's Name--:---- --`w—.r------/�t!a-.-----------•------ :..-•--::::'Phone . �r' ?.__ .- Installation will serve: Residence O'Aparfinent House ❑ Commercial ❑ Trailer Court .0 Mofel,.n Other ❑ Number of living units: _1____ Number of bedrooms!;7--- Number of baths _7.:_ Lot 'size .___.._,-_d�.V_ o P?,C..aF__________________ Wafer Supplyi Publi eisystem ❑ Communi+y system ❑ Privatet--Depth to Water Table .+ ft. 4 .. Character of soil to a depth of 3'feet:' Sand Gravel Sand Loam Clay Loam Clay Adobe Hardn p ❑. ❑ y ❑ Y ❑ Y ❑ _.. pa ❑ O Previous Application Made: llf yes;date.___'__._-..__.___.1 'No New Construction: Yes ❑ No 2-,"FHA/VA:Yes.[I -No TYPE OF INSTALLATIONAND;SPECIFICATIONS: • (No septic-fank or cesspool permitted if public sewer is available within 200 feet.) - vJ Septic Tank: '.Distance from nearest well_________________Distance from foundation---------------.)-_-:Material---------------------------------------- ........ ❑�X/J'T/Iii Na. of compartmentsSize----------------------- -------Liquid depth-----------------------------Capacity------•--•••T-•-•••. Disposal'Field: Distance from nearest well_____' __Distance.f om,foundat.ion.......-...... ...Distance.to nearest lot line........ 45r❑ /. //YG Number of_lines----------------------- ----i---Length of each line--------------- --'-.--�__:Width,of�french-------------•------__-_-----•-_-- -Type of filter material_________ _____________Depth of filter material__«__T_______'__r__.7ofal length_' t...__...__ Seepage �t� /'jorDisfance-fo nearest well__,- ---------Distance from foundation..._I-f...Distance.to nearest lot line.... _.__ Number of pits------- -----------Lining material._+ 4'. _.Size: Diameter..,_,.,:._____:__:Dept h____---�--....}........ Cesspool: Distance from;nearest well____•-_-_.--_--.Distance from foundation-- _______._.__..Lining materiel._.................................. I' Size: Diameter-___-._"------------------!""._.._De th_ - Li uid Ca aci ❑ p q P tY ''-gals, I = . f - --------------_.Distance from nearest building l Privy: Distance from nearest well____...____.____ gr ❑ Distance;to nearest`lot line____--_-- Remodeling and/or repairing (describe):------.--- �/?1!.--_,_ ....C�'f� � .l ._s�'�t✓�i 1. _r...----•--------------- 4 i . i------------------------------------ 1 r �.y ------•-----------------•--_____•-------------•-------••-----•-------,-.-----------•------•-✓--- ----------------------------------•-•--••-••----...-------------•----------••----•-"----..._.._ .-•----•----------------- hereby certify that I have prepared this'application'and that the work will be done in'eccordance�wifh'Sen'Joaquin County f ordinances, State laws, and rules,and regulations of the San Joaquin Local Health.-District. l.'1 Ar (Signed)------ G� .�' /df1/ * ,..[' '- :_ _ )Ow er and/or�Contractor) �. BY: ,.. "_ ---------------------------------------------------(Title)----- -• ------t-----------. --- --"` ------ (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can'be placed an reverse side). .»x FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ----- ---- --------------------------------- DATE-------•-Cl--:--------------------------- ---------------- REVIEWED BY ------------------•--••-----•--------- DATE----------------_----_---..... _ BUILDINGPERMIT-ISSUED..-------------------------------------------------------------—-------_--_-........ ------------- DATE-------------------------------------------------------------- Alterations-end/or recommendations---------------`:--------- - ` - -• - r ..................•-----------------------------------------------------.._------------------------------------•-•-•--------•-----•---•---•-----------•----- ---••-•----------- a . ----------' •-- -------------------------------- ------------ ---• --- -----••--••------------------------------------•---------------- - - x _.. _ r r 7" � � FINAL INSPECTION' BY:. ..-.... Date -•---- ---- ---- . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVI$E6 5-99 YM 5-61 ATLAS