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FOR OFFICE USE: -------------- APPLICATION FOR SANITATION PERMIT Permit No. ........................ --------------•------------- ---------------•------------ (Complete in Duplicate) _._---.--- 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 wok here rin described. This application is made in compliance with County Ordina. . No--v549. w1AN TEt�} r e V N� (�L'd ECF......J r---S•°!7� JOB ADDRESS AND LOCATION_ ... �W ......:74 13)._:x`---------`- - ---- t?.' --- -• ,�...,...r.............:,.�.�.�.::. �..ter.- �.,.,.:.�..�.. ,. ,r-,._., .. ...........y., - Owne'r's Name------�--�---- ----�-- ---,�.�_V�._��?.�-----------------•- ------- Phone---------------------•-•-...-----•-• Address--------- 10,E �[�.1.- ------••--.AI 1�-------�---.. -••----------------------_----_-----------------------------••------------..._---_-------- Contractor's Name-.Nf4�- 4 SES- fC.----��R_V_(_C1a--------- -------------------------- Phone------------------•-----------..._. Installation will serve: Residence.0' Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f.___ Number3ofrbedrooms 25-.,Number of,baths/ Lot isize 1.,5. --------------- Water ---•.......... Water Supply: Public system ❑ Community system 1:1 Private�&`,76epth"o Water fable _ __ ft. Character of soil to a depth of 3 feet: Sand JEr Gravel-[:] Sandy L;3�m Olay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------J No New Construction: Yes��No ❑ FHA/VA: Yes ❑ No ®� TYPE'"OF INSTALLATION AND'SPECIFICATIONS: r Y Y (No septic tank or cesspool permitted if'public sewer"i#=eveileble within 200 feet:} Pft Septic Distance from nearest well-.-s1--_Distancelfrom foundation !©---.--. _.Mgt ----------- r'a . -No. of comartments. - size_M.A1 -A.�-Liqid depth__ , ---_- --.-Capacity...._�^ ! Disposal Field: Distance from nearest well--S . � ....Di_naf *�m�fation---l.0_.........Distance to nearest lot Number of lines. - LegAr, _-V - .....Width of trench----•-3�lin-e!,--•.-•_-______._.-_- Te of filter material. Detth of-fil�fier material_._ !�_! __.-Total length------iQ�._ �_--------------- Seepage _.._______.._See a e Pit: Distance to nearest well----------------------DisaneproFEO O {o_yndation.........:..._...._..Distance to nearest lot line-----_---_-_--_-. Number of asits %__= Linigmaterial __ _ Dia meter----------------_......_Dept h...____________....____________- Cesspool: Distance from nearest well--------------.__Distance.f rmfoundation ... "-----lining material.................... ❑ Size: Diameter--------------------------------------Depth--------------------- ----------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---------------------------------------.---------Distance from nearest building----_---_--_--..___--___--_______.____.._. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------•------------------------•------------ Remodelingand/or repairing (describe)------------------ -------------------------------------•-------------•----------------------------•-••-•----------------------------------------------- ------------------------------------------------------------------------------------------------------------...-----•-------------------------------------------------------------------------...--------------------------- ',-,4 T I v%t_,WA ;'"'.r ------------------------------------ ----------------------------------------------------- ------------------------------------------------------------------------•-- ------------------------------------------- I hereby cert' y that I he ddJMs,,a0f 1!catian and that�tlie,work will be done in accordance with San Joaquin County ordinances, Sta ws, nd lattons of the n Joaquin Local Health District. . .(Signed)--------- ---=- - ----- :-------------------------------------------{Ow and/or Contractor)_ . net By:--------•---------------------- ------------------------------------------ --------------------------------------(Ti+le)---------------------- ----- ------------- _- ---- (Plot plan, showing size of loof system in relation to wells, buildings, etc., can be placed on reverse side]: ,"10 FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY-.--- c_> --------------------------- ---------------------------------------- DATE--------- ------- REVIEWEDBY--------------------------•--------------------------------------------------------------------•---------------------------- DATE--------- -•----•-••---------------------------------------- BUILDINGPERMIT ISSUED---•------------------------------------------------------------------------------------------------ DATE-------------------------------------------------------------- Alterationsand/or recommendations:---------------------------------------------------------------------=------------....................................•---.....------------------------------- -------------------------......-------------------•----------•-------- ----------------------- ------------------------•----------------------------------...------------------------------------------................. ------------------------------------ -----------•---•----------------------------•-- ------------------- ------•----------------- -------- .. ----------- �--------•----------------•-----------------•-•----------------•-•--•---.. ------------------------------------------- 9 � � ��- FINAL INSPECTIO --- Date----- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 305 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8.59 2M 5-62 ATLAS