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^ .. --------------•---- --- -;+ ---------------•-------------------------- -----------:ar. APPLICATION FOR SANITATION PERMIT Permit No. -- -.-�•---..:.. _ (Complete in Duplicate) a ----------------------------------------------- This Permit Ex ires 1 Year :FromDate Issued Date issued .... yd �3 Application is herebymade to the San.Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance"with County Ordinance No. 549. - JOB`JOB ADDRESS AND LO ATION _...... A_R.� ......_•A - .. . -��- Owners Name-------------- ------••-•------ __:.. � _ ------------ { �� ` Phone -1�----•--•..3 Address---•----- .... A--- � ....-----•--•.......................+ --..._.... ._-- - Contractor's Name [ �,.; ----•-•••-----• p `= ""s -------------- ---- 4.-A ------- Phone Installation will serve: Residence A artment House ❑ Commercial y'Traile Court ❑ f ❑ Motel ❑ Other ❑ Number of living units: .._!___ Number of bedrooms __?. Num- ber of baths':: :-._ Lof'size _-_ -_ a Water Supply: Public system P--tommunity system [I Private - ' ❑,. De,pth �to'Water Table ........ ft. - Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sa dy Loam 0'-Clay Loam E] Cla Previous Application Made: (If yes,dote------___.,'_"--__.) No 4 Y [3 Adobe❑ Hardpan ❑ New Construction.- Yes RT14o ❑ FHA/VA: Yes ❑ No _TYPE OE,INSTALLATION AND SPECIFICATIONS: - .. (No aseptic tangy o e ss fool permitted if public sewer is available within 200 fee}. Se tic .,/ P Distance from nearest well 4AJa_-Distance from foundation................ atrial_____ I� QO No, of corn artments._____ _ ......•• p .__ -._.'Size=, x�L Liquid depth____ _- /�_.---...Ca Capacity-__/00 fes. 1. p tY-__/00- --• Disposal Field: Distance from nearest�efL ------Distance from foundation_-:.._ �O__..____Distance to nearest lot ling..=.-�-- 493— Number of lines-________' .._."__ -" _-:'---__Length of each line_____= --• Width-of trenc ...... c. . Type of filter material._. :/ ---Depth of fitter material--------- _-_---Total length_____________•_ -_�_- Seepage Pit: Distance to nearest well_ ' -_-____-- .-___Distance from foundation-------_------------Distance to nearest lot line-_____-__....____ \ ❑ ' Number of pits.---------•-- -----Lining material_----•--�-------------Size: Diameter_-----••---•---••----!-Depth------------- I -- T l ----- Cesspool: Distance from nearest well_________________Distance from foundation...._.____-.----- -.Lining material_____.__.______.___._____.._.__.___._ �� ❑ Size: Diameter. -------------------Depth----•----I---•-----••------ .........liquid Capacity Priv �S. s! tgals. Y Distance from nearest well________-----------------------------------------. Distance from nearest buildin 1 ❑ Distance to nearest lot line____________________ - I Remodeling and/or repairing (describe)__________________________ ------------------ j - ----------------------- t -•---•--- ----___-----••--•-----••-------•---------•--------•------------------------------------------•------------------------------T..................... ...-------------------------------- ----------------------------- ._ ------------••-----••----•---- - ----•--•-------•--• -•------•-••------- •,---•----------------- I hereby certi#y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances Sta a laws, and ru es and regulations of the San Joaquin Local Health District. 5i ned � ., ( 9 )--- ----•• � -•------------'----•------------------------------------------------------------ -----•------ ------------•----------•------- •--------(Owner and/ar Contractor] ----------- ----------------------------------------------- ---�-_ `-----� ---------------------- (Plot .-�----_- �-(T;tla]�,�; ............................... _��-�-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------�--t_R_1 - -" ' - � ----------------------------------------- DATE --- 6_�------------•---------- VIEWED BY ----...-•---------•---'--------- ----------- ' " '" u t'. N f - - --------•-- -•--- --------------- DATE-----------------•-= ------------------------,.� BUILDING PERMIT ISSUED______ __________••--------__-"-------------_----------------------• ---------------------------------------:. DATE Alterations and/or recommendations:---"`.---""------------ --- - .,�• .: - --'-_-�•----;----•----------------•--...-----••-----••-- •• --- -- _---- T zI-µ }, �;� r P- •----•••----••---•--- # : C fJSd = rMR --•-----------••----- ---------------` . r f �� '+ tCtt— SQA -�• c, r , .. ---••- �� I`r± ---------T- .................... ..... In!` �.a �r L� 1-1 i� T w /� � iii v�tvAjc[N "t i; t—c-A FINAL IN PECTION BY:---------- -. - 'y '' . ri TIS FF} CG e r - i ... . •-----._. T N Or � _ SAN JOAQUIN LOCAL"HEALTH DISTRIC'! `i l `` �`� x�'g 1304 OV eQ2 f th Arnerl n Street f t # 300 Wast Oak Srreat 124 Sycamore street 205 West 9th street Stockton,California Lod],California '°� - � Manteca,California Tracy,California ER'9 REWSEa 6.89 pM 3.61 ATLAS