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FOR VFFICE USE:' r Permit No. .1., .__,� APPLICATION FOR SANITATION PERMIT ------------ - (Complete in Duplicate) Date Issued --•�-1.�.- Tfiis Permit Expires 1 Year From Date Issued } Applica#ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h#rein die;}r �� This application is made in compliance with County Ordinance No. 549. Div FPT TA_ , JOB ADDRESS AND LOCA Owner's Name----------_ �� ..-•-•-� .--------- --------------- --- Phone----••. . — 13 Address-•--1 1 a ---••----------------------•----------------- Phone.. -- --------•--- Contractor s Name......---��`�- --•- -------------•---- �' Installation will serve: Residence,❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Otlte� ❑ ' : l _...o.._-bedrooms . Number of baths /_ Lot size --------3----•��Aji. - --------------- ]Number of living units: . Number, . Waters Supply: Public system El Community system [I Private epth to Water Table% _ ft. ' Character of soil rto a depth of 3 feet: Send ❑j Gravel [I Sandy Loam [ Clay Loam [3 Clay ❑ Adobe[� Hardpan ❑ j No j?""New Construction-: Yes �No ❑ FHA/VA:.Y. es E]( No Z Previous4Application Made: [If yes,date_:_-`---.._------- 1 Yd r � 1 TYPE OF INSTALLATION AND SPECIFICATIONSr' �(No septic ta`n or cesspool permttted,Of p uc sewer_is aiyailable,.within,2fl0.feet.}� Ma#enol ........}�r Distance from foundatiLn._-_._- i _ --- SepticlTank: Distance #tom nearest we}1- S ... fXI�N - No. of compartrrients,,------;--------i------- 1 Size � quid depth Capacity. _-A � Disposal;Field: Distance from nearest,•well; Od-----.Distance from foundation--_-1121....__.Distance to nearest;lot line...��r... _ r 5p,- ----••Width of trench__-Z y� j..__... tai ! Q N Number of lines.---------I------------- Length of each line ,---- -- e --i-------Total length ------ Type of filter ma terial._�ir3C7�.----Depth of filter,matetjaL---"� 9 �¢ ' ' - ,_ �: I __.i I--.__-"---."" _-"-"Size: Diameter-- ante to nearest lot line_______________ Seepage Pit: "'"`l. Distance to nearest well-- _..::-__�.�-.__ Distance from-foundation....................Dist . Depth..._.r_.._.-_-.'..-_-- r ----. ❑ 1 Number of pits.----"----------------Lining materia I } __ - ] q Lining P tY Cesspool: F .4. u .-_gals. - ..• Size Diameter nearest well------------------------------ ----- -------©ep}hce from foundation--,----------------Liuid Capacity_ -• -"- � r ❑ ------,-----------------Distance from nearest building ' Priv i • Distance from nearest well-----------------�•----- �j •----•----•=u�----•-•--s•----..__....-. y' . -------- I ❑ 1 Distance to nearest 1 t�l'sne_..-__- --- .,,., ,s i' , � -- l _._. .. Jelin :and or ,re aif":describe - ""------ "" �� Remo gF p ) t _ ---_- ---------- 1. _ prepared ---------------- -----------------------. ---•---__--- Health'Disffict, ' I herebyy certifyt at I have re ared this a plicatio San JoaaumhL calk will be done in accordance with San Joaquin County i ! ordinances, State and rules and reguietio of the q xi 6 .y I i ! - ------(Owner and/or Contractor) - _. ... i (Signed) - ------ .I'll► „ -------------- f � .(Title : 1 = = ------. - - B ' -.. _ By: - ^' "" buildings, etc, can be placed on reverse side]. (Plot plan, showing size of lot, 16 tiOn of system in rely#lore to-wells, } FOR DEPARTMENT USE ONL* _ ----------------- APPLICATION ACCEPTED BY - -#--.�' -`-- 1 DATE __ —�- :... DATE---------------- REVIEWED BY. DATE.:-•--------------- BUILDING PERMIT ISSUED---- w------------------------------• ------•----------•---- . # t Allterations and/or recommend'atiorth------- ----•------------ ---------•-------------- •---------------------- 1.. I �' -•-"-----•------•-----. ---"-•-----•--•----------....................... k- t ----------------------------------.---- ------------------------------- I I ---------- --------- •-------- ------ ---- --•------- --- ---e4 - --------------------------- "� FW L INSP TION Y--- -------- ---------------------- --------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wort Oak Street 124 Syeamore Street 205 West 9th Street 130 South American Street Trac California ➢ Stockton,California .O Lad[,California Mantecay, ,California / E8 9 NEVISto 8-94 2M 3.61 ATLAS