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FOR OFFICE USE: ....-----•------- ----------•-•••---------•......_..... . _r APPLICATI6 .s N. FOR SANITATION PERMIT Permit No. ... �� ...............•...... ......... (Complete in Duplicafe) ..... ................ 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 I'nsta the w�orE hero described. This application is made in compliance with County Ordinance No. 549. h?f}N TE-Cf-4 r J08 ADDRESS A v-V D LOCATION- _Q_... ..P. .....1..Y�.Z-E....1�� ------ ..---QF--•---UAVIQ.N--------(- b--+-•--------------- . C Owner's Name.- --..t4- .-. .nF-Rp_jF�N....... n'�_>��V.T/9R ......... +Q .--- Phone---•-••--••-•............_......•-- Address......"1.Q.-t'.A....._.-,Z;4..... ....... jx_-:-P, ........../k•/qLy.7Fcjq_ ---------------------------------------------------------------- - Contractor's Name- -!11� T _� .._.._ti�Z i' l.-1�,.,.. -t. .(.CRS•....-..-•---•---•............... Phone..........%.......... . Installation will serve: Residence rtment se ❑ Com . rcial Trailer Court ❑ Motel ❑ Other �,�HCPL- Number of living uni ""lQumber"6f badr __.a�umber of� T o slie ..-...,� 6.Y � _...---------_......_ Water Supply: Public system ❑ Community system ❑ Private.Qj-"`DGpth To Water Table 6-ftg Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑ Adobe❑ Hardpan Q Previous Application Made: (If yes,dote........ ........) No q New Construction: Yes 'o ❑ FHA/VA: Yes ❑ No®"' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Se t' ank: Distance from nearest well-110-0-. Distance from fou dation.../G�------- No. .--.. p No. of compartments-..----- .-._._----__-Size._2.��_-_--X_5<..._•.Liquid depth.... ... Capecity___..rQ 0 DispaseI ield: Distance from nearest well...1l�.Q.Distance from foundation.....le.......Distance to nearest lot line--- .......... fi ' Number of'Fines._......... .................Lvin4tfi of each Iine.;,iJ.pQ... ......Width of trench.......... ............ Type of filter material._. Q ._K..Depth of filter material.......li$7.-_-...Total length---------- Q Q ............. t Seepage it: Distance to nearest well_-..��.Q.__.Distance from found atioe.,,../0 _-.._Distance to nearest lot line...... , Number of pits......../.............Lining metarial..P—A�-�i.'.Size: Diameter..20.X3pDepth....... 1� Cesspool: Distance from nearest well.................Distance from foundation....................Lining material.................................... Cl Size: Diameter......................................Depth......... r;.!...........................Liquid Capacity........................_.gals. Privy: Distance from nearest well... ..................... .............. . . ..Distance from nearest building............................. ❑ Distance to nearest lot line.......................................••---....._..--•--•............_.•....-...-••--•... ••................. ............... Remodelingand/or repairing (describe):..................•-••••--•--•••......-....---•-...... 1--------_......................................_........-...-......................... ..........._._.._.-...---.............................................11----.._---•-•--•1111•-•--••11••11---•1111....--7........................................................................._...-........... ---------•---•----------------------------------------------------------------------------------------------------- 4....._J...3------------------------------ ................................................•-•--•--.......-•----.-.....--••--•............- C---................................................._......................-.................. I herebyy ce ' y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St w and rul"mrid,re Mations of the San Joaquin Local Health District. ,r 1 (Signed)----- ....•c�c-�v ........ .....�: .......... s..__.._.... - -. •.......(Owner and/or Contractor) IF By:_.._............................•.. .... f----•----------- _-------------------------(Title)-.------......-- ......... .•..... ..................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORbEPARTMEN-T USE ONLY APPLICATION ACCEPTED BY.... �-*�i.... .............. ............................................................. DATE._..... ..`_ r ----------- REVIEWED -------REVIEWED BY--------------------------------------------------------------------t........:.........................-------------------- DATE--------•--•------------•------- -•-- BUILDINGPERMIT ISSUED---------................................................ ----------------....--•-•-••-•-...---- DATE- ------------------------------ Alterationsand/or recommendations............................................................................................................................................................... ................,..... --....-----------t-...-.......---....----.-.--.-.....-------.-.-.-.....--------••-------------------------•--------------...._.......-......-•-----..-....-......------------•------------------- ---•--•-.._...-:.....-••••••----.......-„.�;t---------- -------------•------------ - ........•---- -•.......................................................................... <.... / - •----------•---------------------------------1111-- -- 1111- 1111-- ..-..1111--- ..:.- --- - - -•------------------------------------------------..------- ------------------••---•1111•--......-..---- 1 ? � Da.__..... ..•--- -.FINAL INSPECTI .3.. ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street .'205 West 9th Street Stockton,California Lodi,Callfortmlo Manteca,Callfemle Tracy,California E6 9 REVISED 6.59 2M 5-62 ATLAS f