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l "--' rc,lrJ//�b ---------------- ---------------------------- -------------k Z 4 % ; ---------------------�-------------------------- � LICATION FOR SANITATION PERMIT Permit No. ---L`E_S•�.`/... e. -- --------- --------- --------------------------- (Complete in Duplicate) I., {c ------------------------------------------------------=�-- This Permit Expires 1 Year From Date Issued '� Date Issued ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance wiitC% y rdinance No. 549. JOB ADDRESS AND LOCATIONQC.>- -------------�.� '.. .�1 + ........................ t Owner's Narrle-_."k-= �t..,..__:�LCV_ 4f',' ----------------------------------- ----- _--_fil;ac, Phone_... Address._._4. 3__ �l.d .................................... Contractor's Name------ !A _!� --------------------------------------------------------------- ---•-------•-----••.----....................... Phone................................ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �. Number of living ... un.its:�__ Nurnber_.of bedrooms_a�....,Number_of_.baths_Z__Lot size___1.Q4--...._-y_....I_4 -•.r... .........:.. Water Su ! I Supply: Publicsystem: �, Community system ❑ Private ❑ Depth to Water Table_ ft. � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loarri ❑ Clay ❑ Adobe J& Hardpan ❑ Previous Application Made: (If yes,date----------_--- -----) No E 1 New Constructi in: Yes No ❑ FHA/VA: Yes ❑ No t!j- TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well__V1 Q_ _bistanceI from foundation --------Material__T_Ed V__p_C A ...................of compartments 2 ----Size-��.JA16._k. ,.�.Li4uicl depth-------- CaPaeity..1 .Q_0... Disposal Field: Distance from nearest well__y p)A_E._.Distancel from. .foundation r4(2x .,A_-:-.Distance to nearest lot line_,i......._._. Number of lines------ Length of each line -._____ .Q------___E_.'_.Width of trench------- Q-"...----• Type eter material-rooz-- ----------Depth of filter material.__ length......1 - _-----.--------_---- SeeP Seepage Pit: Diane tonearest well --------------------Distanc? from fundatiol-_-_---_-_. Dis+ante ^ ) to nearest lot cine.....______.___ ❑ Number of pits----------------------Lining material-- -------------I-----Size: (Diameter_---•---------...---__-.Depth__.-••-------------•---...----_-- ❑ Size: ce from nearest well-----------------Distance from foundations----------....V____Lining material�'_.- ass ool: Distance f eter-------------------------------------Depth---1------•------'._.. .1. 1 Liquid Capacity.. gals. p --------- Privy: Distance from nearest well. ________________________•--- ' L M. 1 ._.�:____--t__Distance from nearest building ❑ ;.Distance to nearest lot line---------- _ F Remodeling and/or repairing (describe):_____________________________ "_`______:_______ __- _ ----------•-••-------------- ----------- --•------------ 4 -----------------------r-----------•----------------------------- ------•------ - ---------•---------------- •------- 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 JoaquirrL•ocal-H ealth-District.---� (5i ned -1-_. I 9 ) ------. ----•-•--- (Owner / -------------•------------------------ ---------------• ------...--------•-------------------...-----.._._.---IO rend or Contractor) BY: f k ....; j {Plot plan, showing size of lot, Vocation of system in relation to wells, bu(dings,etc, 'an be placed on reverse side). FOR DEPARTMENT USE ONLY �• { APPLICATION ACCEPTED - --------------------------------------------- -------------------` DATE- --6:7-_GqREVIEWED BY------------ DATE- - -•---------- - ------------- --------•--- ---•-------•- BUILDING PERMIT ISSUED. •- --•--------------------------- ------------. DATE Alterations and/or recommendations:._.___.____.._.._ ----------•------------------------------------ ------- ----------- i----------------------------------------------------_----------------------- ................................ y.. ________________________________________________________________________ 5 ---------- ----------------------------------- ' ILL. f + FINAL INSPECTION BY:----- ------------......... ........ ------------------- Date--. G. ------------------------------------ f i SAN JOAQUIN'LOCAL HEALTH QISTRICT 130 South American Street 300 Wes!Oak Street 124 Sycamore Slee! 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-99 2M 5-61 ATLAS s