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__ ______ ___________________________________ ------- APPLICATION FOR SANITATION PERMIT �J'6 Permit No. V ..._.. ._ (Complete in Duplicate) ------------------------- This Permit Expires 1 Year From Date Issued Date Issued 6211, v Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. rt This application is made in compliance with County Ordinance No. 549. ,, Pl1�Q-TCS JOB ADDRESS AND LOCATION-__.._� _.. '!1."_.W j Owner's Name--C! l Address---�-�.tj Q.------ --•----- --�/G'(r-f�c.Gvf.,-------•�-•-'-- - '. --------•--------------• -- ., Phone.3. .. . ._�...... --- A .......................... •........................................................... Contractor's Name.___ ' •------ .-------_------ PhoneT�.�.�._c�3 Installation will serve: Residence �f Apartmen�ouset Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _L___ Number of bedroo _ Number of bath Lot size Wafer Supply: Public system ❑ Community system ❑ Private P Depth to Water Table � ft. 0 .tl Character of soil to a depth of 3 feet: Sand P Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: flf yes,dote----- --------------) No WI New Construction: Yes ❑ No ❑. FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATIOWAND SPECIFICATIONS: ; - - ' _ -A - ---- - - - .� (No septic tank or cesspool permitted if public i sewer is available within 200 feet.) Septic Tank: Distance from nearest well---A------Distance frQ o_undatior_1Q-"--------•,Materia1.�� _--- No. of compartments___________ __________Size__67f l a Liquidepth._. `--------•-- CaPacify.��.� U. Disposal Field: Distance from nearest well--- Distance from foundation.. __ / 0 S Rq-_-•_.___..._ Distance to nearest lot II;nes�.............. Number of lines-------_. th of each line_____�- --- C�--.Width of trench.. __1i�______________ l� g F;- ll ---------- Type of filter material._.�•.�-----9 pth of filter material-__--______ Total length-----A..0.-' Seepage Pit: Distance to nearest well----------------------Distance from foundation----............__..Distance to nearest lot lin e._____....____... ❑ Number of Pits---•-----_---_-----Lining material------------------ Size: Diameter Depth ---- esspool: Distance from nearest wellDistance from foundation--------------------Lining material__._--___....____-_-- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity Privy: Distance from nearest well________________________________________ Distance from nearest building ❑ Distance to nearest lot line Remodeling and/or repairing (describe)___________________ -•----•--------------------- -------------------------------------------.------------------------.-------•--------------------------------------------------------------------------------•---•---•-••----•-----.-....--•---._...----•-•------------. --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun..ty ordinances,ZSfaaws and ruh nd re tion of the San Joaquin Local Health District. (Signed)------- . r -----•----------------------------------------------••---(Owner and/or Contractor) By:..........................•------------------- ...-------- -•- --------------- - Title (plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I + +_C ` REVIEWED •- -- - -- ----------------------- ----•------••------------•---- DATE..----- , 4r----- ------------ BUILDING :-- ---- BUILDING PERMIT ISSUED_ --- -- -- ------------- ---- DATE---------------- ----------- --------------- -Alterations and/or recommendations_______________________ � ------------------ Pt3SFA - s�P r+� 7R�rc ------------:tR rvr_i s ... ; ------------------------------------------------------..--- ----------•-•------------------------- } --------------------*--------------*,*-*------------*---------------------------------------------------------- -- --- ----•---- -- 1 �j FINAL INSPECTIONtiBY,- -------- . . Date _✓ SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California E$ 9 REVIsEo 9.89 2M 6-61 ATLAS