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FOR OFFIC VSE: --------------- ------------- APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. ...,l..�.�.3.z' ------- ------ --- - ----- (Complete in Duplicate) . date Issued ................ �_ -----------------------_----------------._..___ -_.___ This Permit Expires 1 Year From Date Issued f � �--• Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 Ili"_-_.... JOB ADDRESS AN OCATION------ ---- - ----------------------------------•------•-•---•-----....---------- ---- -- ................... Owner's Na -- Phan d: ..`f Addres .. .. . ----••-•---•---------------- - Contractor's Name........... a --------------- -------- Phone ----l.—.�V.de ff Installation will serve: Residence/ Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other E]Number of living units: ..!-- Number of bedrooms .,czz Number of baths __!____ Lot size -._---_-.-_•. Water Supply: Public system ❑ Community system ❑ Private OR-155epth to Water Table�,� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam [I Clay Loam ❑ Clay C-] Adobe�ardpan ❑ Previous Application Made: llf yes,date____________________) No New Construction: Yes ❑ No 93--__FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tI anki Distance from nearest well_________________Distance from foundation!_...__..__________.Material_______-_______________.......................... No. of compartments---------------------------Size_..---- -----•----------------Liquid depth--------- ........—Capacity------•-------------•-- Disposal •eld: Distance from nearest well-74-__ Distance from foundation.- _ v�_4___.___.Distance to nearest lot line __ e, Number of lines________,_ _____ __ Length of each line..______--6_`_.....___..Width of trencJ ....... �__________-...... Type of filter material._E� _Depth of filter material___�,�_____.....Total length---_-----------------m�...... Seepage it: Distance to nearest well-/0Q_.f-------Distance fro fo ndation_.... 40_f.....Distance to nearest lot line&.o]`___.. [ Number of pits______ Lining material.. Size: diameter-_, .". Depth a ` .......... Cesspool: Distance from nearest well----------_------Distance from foundation--------------------Lining material•-______-.___________.._........... ❑ Size: Diameter--------------------------------------Depth-------•--------------------------------------------Liquid Capacity.....__------------------•-gals. Privy: Distance from nearest well_________________________________________ _______Distance from nearest building----------------------------_-_-----_____. ❑ Distance to nearest lot line---------------------------------- -----------------------------------------------------=----------....__.---------------------------••------ Remodelingand/or repairing (describe):------------------------------------------------------ ---------•--------------------••------•-•-•-•----•-----------•-------•------------------._....---- - --------------------------------------------...........--••.------------------------------.-•---.----------------.-.------------.---------••--.-----------.---.-----------.-------------------------.----..---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance tate laws, and r s and reg ations of t San Joaquin Local Health District. (Signed) ----------- Owner and/or Contractor] e By:------------------------------------�— = (rifle)(Plot plan, showing size of lot, location of system in re to wells, buildings, etc., can be placed on reverse side). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__1� ---- `"'"-`� ------ DATE_____ — 2 - - - REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE--- ----•---•----------:.:-•-------------------------------- BUILDINGPERMIT ISSUED_----------------------------------------------------------------•-•--- - ----------- DATE----------------------------------------------------------- Alterations and/or recommendoions:- /:F- --------------------------------- = �� " -------•------------- tl� 'r •� :_L _._..._------ �•. - � "- ` - '- - --�-�f�-`-vac-=�/O-Pc: --------- _•___..___�y._ _....__•-. �_ __ -'` 'F_'a^Y...s�___y�f�eL__ .......... �-- --•--- _ - t ------ -- - -• --•-------•---- -•••RFs-y>.vr3-•f'—'-`-- .3R=\--� - .�'---�--%Z'-- -lr�-^-�' FINAL INSPECTION BY:---------------------------------------------------------------- Date---------- J / SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Street 124 Sycamore Strout 305 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 29 9 REVISED 8-89 2M 8.61 ATLAS