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t FOR OFFICE USE: J APPLICATION FOR SANITATION PERP+tR Permit No. ......_.__....... n u cae /0 I ,. ._ (CompleteiDItt •• c11 S Date IssuedG..Z- This Permit Expires i Year From Date Issued ,si t I Application is hereby made to the San Joaquin Local Health District for a permit to construct" nd install the work herein described."" I This application is made in compliance with County Ordinance No. 549. JOB ADDRESSLAND LOCATION___ _� .L.._... __.w��Q -•-•----•--=---- l t --------------------------------------------- ----------•.....-• } Owner's Name.al2W..... /QiF........&,�POce ✓1/.I ...... --------------------------------•-•-•----- Phone. _-_-_____O.__.S---jaeZ-__ Address------------------- 35.8 � L?/iYQ..._<�/ Y---------------••------........------------------------------•------•--------------...---•-----------•-------- Contractors ---------------------------------------------------------- Phone._!�!�P69 T- Installation will serve: Residence Qr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _/.i. Number of baths _�..__ Lot size _..>S.-OI._X. -.__7. ............................ f Water Supply: Public system Community system ❑ Private ❑ Depth +o Water Table Sa.. ft. Character of sail to a depth of 3 feet: Sand F] Gravel [-] Sandy Loam El Clay Loam 13Clay ❑ Adobe El" Hardpan❑ t ) No New Construction: Yes ,_,/No FHA/VA: Yes No ❑ Previous Application Meda: (If yes date_.._.._, __.. . � 14� ❑ ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / Septic ank: Distance from nearest well./YVNW___Distance from foundation_-.-C�_�...._.Material____A d�.'?A.-/........___. 1 , ( No. of compartments.---------Z........... Liquid depth__...Y.-.--....-----Cepacity--el � r , Disposal Field: Distance from nearest well_/_.VQ.IY.._Distance from foundation_--/!2-----------Distance to nearest lot [1 Number of lines............I---------------------Length of each line_--�7�..._._-_.......Width of trench.. ---------- Type of filter material----RACK-------Depth of-filter material-----1_�'_.__....Total length...._._..._. ' Seeps Pit: Distance to neerest well... Peek_...Distance from foundation----�:-_.___Distance to nearest lot line.-S-.0....... 1 -Number of pits........ ------------Lining -----.Size: Diameter.--_33...........De th...... .5_.'................ P Cesspool: Distance from nearest well/:.............Distance from foundation___.-_-.-_.-.._.....Lining material----------------------_.............. ❑ Size: Diameter............------ ------------_-- Depth----------------------------------------------------Liquid Capacity------_----••-___------gals. Privy: Distance from.nearest well.................................................Distance from nearest building__--_--._._-.-..-___.___..____._-----.-.-. ❑ Distance to nearest lot line...-------------------------------_--..............................................-•-•-- ._...._..... . ' Remodeling and/or repairing (describeJ:--. TC/1?.... -0------eZ._0L.,07vc_-_ /Y,f_-'� ---------------------•-• ., ----------.....................................----------------------------------------------------------------.------------------------ ---.-----• -- -•--•-------•-•-•-•-----•----------••-- ----- ----- -----•---------•-•-------------------------------------•....-•---- ----- ------------------._...----------•--•----- •----------------••-- 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)--------- ------- -----------------------------------------------------------...(Owner and/or Contractor) --------- BY:.- ... ac - ....... .......... ...... {rtle) - - (Plot plan, showing size of lot, loco on of systern in relation to wells, buildings, a+c., can be placed on reverse side). e FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY - _r - ---------•---••----- ---•-- ' . DATE--- ....... ...... t REVIEWEDBY..--------------• ...............:... ........ . ----------•---••-•------------� DATE ..... .._.-- BUILDINGPERMIT ISSUED------------------------------ ------------••-- --------.-------------------•-----W ------ DATE- --------- Alterations and/or recommendations:._./ ,r .... - ------ -.- L .-.-. .•.•-.--.• . ................. ....................................... ........ .....•--- --------... ...-.. .------------. ...... ..--- --`............---....••--•-......-----------.............. -. . :.....-- -..:---.-_rt--. ......------ .�.r._.. ..,_� _ - FINAL INSPECTION B �r � ,._. _.- ------------ , �.Date.........1_U.... �. �_.-. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Proof 124 Sycamore Street 205 West 9th Street F Stockton,California ledl,California Manteca,California Tracy,California ES 9 REVISED 8-119 2M 5-61 ATLAS