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FO OFFICE USE: -------------- ----------------------------------------- APPLICATION F-01� SAN`1TATION PERMIT Permit No. (Complete in Duplicate) / _ _ ' ___-__-_____.__. Date Issued __. This Permit Expires 1 Year From Date Issued y 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,* c mpliance with ounty Ordinance No. 549. 2`f 7- <�� SSI„ON 2 83 is 2.. ✓�rjiEC,At Kr, ti ' �V` Sipr— ........ JOB ADDRESS AND OCATION------• fS - ' -� ..j-0Hj%-- ! n ; E+ Owner's Name---------- ----R_T.�-UR--- -•--APR1_A -_..-----•--------•--•----------- ----------------------------------- ------.----- Phone.................................... o Rl Address----•--•-....... RTZ--- � K-•--- -- 7-�5---------- C Con+rector's Name.. f� :...� 1 --------- --------- .-----•---------•--•---.------ Phone -•------.•..- ..._.. a Poo a— n rrfiler Court ❑ Motel ❑ Other pHTi•F MOVSjE.' InstallationNumber o u n-1-N Numbe of bedrooms�_=__CN Number Commercial baths__�.... Lot size ____-- -.-..••-••--•-------- �' I Cj .ft. Water 5u Public s stem Communit s s m j] Private a th #o:lWater Tab a.�- ,-_ Supply: Y D Y Y p r .+.�.. Al Character of soil to a depth of,3 feet- and Gravel ❑ Sandy Loam ❑ Clay Loam ❑ CClay ❑ Adobe❑ Hardpan Previous Application Mede: [If yes,dote______ ___________1 No New Construction: Yes �/No ❑ FHA/VA: Yes ❑ No TYPEWOF INSTALLATION AND SPECIFI ATIONS:T * %, ','.. (No septic tank or cesspool permittedkiiff public sewer is available within 200 feet. 09 Distance from foundatiol _ _.-...__Mial... [ 7. DO iSe tit k: Distance from nearest 1K Ncompartments.___. --•--Size.. depth Capacity----- �ti e Disposal Distance from nearest weIIQ _Distance from foundation----I0.........Distance to nearest lot Grt r Number of lines..........____�}} -____ Length of each line..... Width of trench,--- ' Type of filter matenal._._.�]Q:G�1 I]ep of filter material___._ .�.�-_____Total length.......... ....�.....___.__.' y /� I ., p g Linin material... �� 1___5izon___10--_._...Distance to nearest lot line___. .......i See : Number of p1}5 rest ;ell_-- Q. Dista l...Xom�foundate- Dia mete r..Y-X_/_��._...--,Depth--_-4�_____ _____________+ m i1Y t �, �� _. Cesspool: Distance from nearest well-----------------Distance frdrrnPfoundation Lining matanal: I............------------- h• ❑ p Liquid Capacity 14 �. ' ---------- ----------------gals..�: Size: Diameter----------------- ---------------....-De th----�---�--------------------•--------------- -- --- - Priv Distance from nearest well------ _-__ � �;_.__,-_4-"f`Distance from nearest building_________________„_____._____._._______ _. ❑ Distance to nearest lot line- t I � :_.:.... ._.. f -=--A I Remodeling and/or repairing (describe a ----- -•---=-----------------------------••--------=---------------------- •----------•---...---•- ---------------------------------------- `---------------------- ------------- -------------------�.._..... -------------� .....................----------------------- , ,► ------------ - ==_--_-- _ -------------------------- - rex y#�^�y y prepared pp q k will be done in accordance with San Joaquin Coun I hereb --certify fhat l'lia've re ared this application and that the wor ordinances. State laws, a rules and re lations of the San Joaquin Local',Health District. u /� (Sigried�- . -_. .. .....Jl ”- - ----------------- --•-•----- ---.-•-•-- ,�..--- --( er and/or or) — � ner a Contract Title By:..................................................------------------------------------ ----•---- -•-;:-•-_.-------- ----------- ( ) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USP ONLY } APPLICATION ACCEPTED BY___._ - - J-- ------------- -- ------ -----. ' ----'�±,P--"�-��.� DATE =' �j'` REVIEWEDBY-------------------------------•--- ----------------------------• --•--•---------------I--- ------•---••••-•--...-------_._._ DATE------.... ---------------------------------•-----•------ BUILDINGPERMIT ISSUED-------------------------------------------------------------_1-....................I........------ DATE-----------I--....----------------•--•--.-----...---------- Alterationsand/or recommendations:----------------------------------------- -------cm•=_-__-----------------------•----...----....----------- ---------------------------------------------•- ;" - -------- -------------------------- -•--------------------------------------- --•• ------- ----------------- ----- --- - --- -- ----------------------• ------ --------------------------•--•-•----------------------------- ' ,, l FINALINSP Date---------- ... .-. --------------------------------- SAN JOAQUtN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak STroN tii�24-kycamorf Street 205 West 9th 5tno1 Stockton,California Lodi,California # artaaa,California Tracy,California ' EB 9 REVISED B•99 2M 8-61 ATLAS - -