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FOROFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _.�.��..� ------------------------------------------------------- (Complete in Duplicate) �7// G v --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ........... ......... Application is hereby made to the San Joaquin Local Heaith District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---2_/1/r!'_,e1, Tp F Tf�c I�TrYc l �!-_- ate.-,/=�J iI 7-o 1v -----. . Owner's Name---------Tp�--------F�eh., 2&---------------------------------- -- PhoneA1i?..(.3"7o63 -- Address-------.. Vi-_,l------ k_T N... - Contractor's Name------ _f( !'r�irc So�v �' Phone ! _3. y'2l 7 --------11 '..1 ------•-------- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms _�V_____ Number of baths 9.._. Lot size ............................................................ Water Supply: Public system ❑ Community system ❑ Private'®' Depth to Water Table S_yft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam J@ Clay ❑ Adobe❑ Hardpan f�- Cesspool: Previous Application Made: ilf yes,date--------------------I No R New Construction: Yes Ig No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q' Septic Tank- Distance from nearest well_hp__rrDistance from foundation--- El oundation-•Il No. of compartments-.-.------------------Size__yxr_ '_�p----Liquid depth._...._.y-------------Capacityl/ 1�0.......Disposal Field: Distance from nearest well._1 01T Distance from foundation-_-�.- /.___.Distance to nearest lot line.............Number of lines_____________.__l Length of each line_______�Q'____________-Width of trench.... ______________-Type of filter materlal._�"___ .__Depth of filter ma"terial_____ �_��____._Total length______.6�-�....................Seepage Pit: Distance to nearest well_--- ��_ __Distance from foundation_._...... ..__..Distance to nearest lot line.............,® Number of pits_______ -_.-_-___Lining material_. Q_ -�-___Size: Diameter_,.... _y____.Depth__a_4~_-------------------Distance from nearest well-----------------Distance from foundation-------------------.Lining material..................................... ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------_---•gals. n Privy: Distance from nearest well----------------------------------------------- from nearest building__--___-__-__---_--_-_-___________-__._ ❑ Distance to nearest lot line----------------------- ------------------ ..................---.-.---------------------__----------.------------•-•--------- ------ Remodeling and/or rep firing ��-l�_-r.. ---•-C��/e�.__1, --- � •-�-�'f�''�`�-----`-��-S'xr_:4-------- -�'-c=--/�u�s�.r----:�-y- =��-'E'k'=''----��Z.L'lf_.�J..��._s�'r_ ' 'G•-� ._ ---------------------------------------------- ------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed).............. ----1_a ----------`t` �J------ ------------------------------- ------------------------------------(Owner and/or Contractor) By:....... -.C '-- —.f . _ _.:{ = trifle)_. ..G ��i. (Plot plan, showing size-of_lot, n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ _f-..__ .. - __ __ ______________________ DATE-----7_ __�-�a�_--- -- ..__ ----------- REVIEWEDBY-----------------------------------------V-------------___----------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------.......------------------------------------------------------ DATE------------------------------------------------------------- AJterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- -------------------------------------------------------------------------- ------- ------------------------------------------------------------------------------------------------------------------...---------------------- --------------------------------------••-------------------•-•--........ ----•-------------------------------------••-----------------------•---------•------•---------------------------...---------------------------•----- FINAL INSPECTION BY:..-J----- ------ -------------- Date-------- .T • .•-- ----•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E8 9 REVISED 8-89 2M 8.61 ATLAS