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FOR OFFICE USE: ------------------•------------- Permit No. APPLICATION FOR SANITATION PERMIT ------------------------- ------------------------------ (Complete in Duplicate) Date Issued ---------- f This Permit Expires I 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. LA This application is made in compliance with County Ordinance No. 549. -17H ROT>- JOB ADDRESS AND LOCATIONX.... -- _--------- ---- -------------------- Phone-------- .... Owner's Name....----- I.-C) J�� - VIY-------EjERRE-K-A-----------�AN Address------------Rr = ------- ------__...........;.__,_H_Fo_'P_......................•----------- "--•--•--•-----••------• IN � it A ......_......... Phone............... ....... Contractors Name.., .11THOFF---------706_;MARI-0- .4AN.T %-'---X Installation will serve: Residence [-] Apartment House El Commercial 0' -Trailer Court 0 Motel ❑ Other 'DVP Number of living units: . Number of bedrooms Number of baths Z7 - Lot size ...... 1- -_ 0 Prii�ate Depth to Water Table IV- ft. Water Supply: Pubiic system C1 Community system �Iv _1 Character of soil to a depth of 3 feet: Send �XGravel F] Sandy Loam Clay Loam [] Clay [] Adobe[3 Ha' rdoan 0 Previous Application Made: (if yes,date--- ---------------- No 2-111,New Construction: Yes �o El FHA/VA. Yes V No 01 . Al . ... TYPE OF..INSTALLATION_AND-SP_ECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available.within.,200 feet.) BE, Septic Tank: Distance from nearest well ------Distance from foundation.-,-,/O-------Material.<_a....Al..0... . .... I. ........ h--- -—--------c6pecity.21�2_S-0 No. of compartments---------�Z------------Size-5- ------X__5_,___Liq,id depth___ .................. X-1 A V9 it defion....149---I......Distance to nediest lot line----- Disposal Field: Distance from nearest well-L.-5- __..Distan�e from foun ir '"44 Number of lines-------.-- -----------Length'lof each line_1_P:4:--- of trench-----W ii;xll 7------ " Type 0 -filter Length filter mater A------T(5taislength!...... y f --- D;pth !ill 11 9% 60 . '1 Distance to nearest well/e_0_,/*iV1 Distanc,e from fot;Qdaticn_/0.W.n),Distance to-,nea rest to Seepage Pit: f eAr ii lame - -------Depth- ..............T Number of pits--- Lining material __S T7D ---�1_ '0 14 /--------------- � _RP- I...0 1------to- - Cesspool: Distance from nearest well--------_-------Distance from foundation-------------------1ining material-. ..... --------_--------- I . 0. k 1 -0 -------nnInDepth--—------- ---------I-------------Liquid Capacjt�----------- ---------ga --------- ----- -Distance from nearest building_ ---------- Privy: Distance from nearest welL------------------- z-o%* ......... •..... .........------------- sf f ine------------------------------------------------ - -----------------------------....... ❑ Distance to near _0- Remodeling and/or repliring (describe):----------------------------------------------------------------------------------------------__--------------........ ----------- • ----------------------------------- -------------- ----------------------------------------------------- ---------------------- -------_------ ---------------------- ...........---- --------- --------- -i------------------------------------------------ I 111. 1. -------------..................1___..1----------------------------- --------------------------------------------- ...---I ------1------i-------------- 1--------4........--------------------------------------------------I-------------------A-------------------------------------------------)----f...k-------I---------------- -------------------------- --------- I hereby certify thkf,1,have,prepared this,ap plicati6fi—aln-di th�kv tK6:imrk__w_ill be done in accordance with,e San Joaquin County ordinances. Ste laws, an rules and regulations of the San Joaquin Local Health District. ............................---------------------- ---------------------._..----------------(Own and/or Contractor) (Signed)---X4--------- . .... -�, -- ._- I ; � - - -4 - - - -------------- By:--------------------------------------------------------- --------------------------------------------------------------------------(Title -----------I M, (Plot •plan, showing size of lot, location of system in relation to wells, buildings. etc.. can 6e placed on reverseside).�, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- f---2-R-'-Q'------ ----------------------•--------•--•--------------------_ DATE----- ---------_---- REVIEWEDBY------------------------------------------------------------------------------------ ---------------------------------------- DATE_...__..-----------------_----.........Y---------------- ---------------- DATE------------------------------------I... 11---------------- BUILDING PERMIT ISSUED............. ---- Alterations-and/or recommendati6ns..---5-fze:---Cf+4-Pt-f-4&tk-%'�so ............ ....... KA A ................................ ---------_--- ---- - ---------------_------—---------------------------------------------- -------------------------------------------------- — — %, ` (1 .... .... . ..... -— ---------------------------11-------------- ---------------------------------.............................I----------------------r----------I------------------------------------- I -------------------------------- _------------------- --------------------------------------- ----_-------------- ------------------------------------------------- -------------------------------------- ---------------- ............. ...... ......y-- ----------------- ... ----------------------------------------------- ------------------------------------------------------- ------------ ------- ------ ---------------- FINAL INSPECTION Byt -- ------- Date----------- ....... "LA SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo west Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REvisEo 8-99 2M 5-61 ATLAS