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I I Vf\ VI / I%--6 VJL: n APPLICATION FOR SANITATION PERMIT Perini+ No. ...�.-_.�_$ .5_ ----------------------- --- -- - (Complete in Duplicate) moo_ y .._---__ ---------- ------- -"_ This Permit Ex ires 1 Year From Date Issued Date Issued ___ l.._____._....... -u Application is hereby made to the San Joaquin-Local Health District for a permit to construct and install the work herein described. This application is made in complianip linty Ordi`Ktcey�(o_ 549. JOB ADDRESS AND LOCATIO . fEll� :...GG.��.��.ff---------------- ---- ----------------- ---------------------------•--------- Owner's Name......... e..-•--•• '4!'► 1.. ` Phe e_.5�•7x_•'�8'iS -"----------- - -- --------------------- ---•-- .......... Address.... 'J,r ........ /y`O. s�_ y -- - -----y Contractor's Name_.-_..� �9NT Q,v -,,--'`1,SQ/11-----\---• \— ---�6c-.--17 a ----_�-------------------------------- Phone-_S.Z 3-y.7/. ...... Installation will serve: Residence Iff Apartme t House ❑ 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..._-_ Number of bedrooms ___.\Number of baths ?____ Lot size ....l- _ cr......................_....... Water Supply. Public system ❑ Community13ysti m ❑ ',Private ® Depth To Water Table ________ ft, Characterof soil to a depth of 3 feet: Sand ❑ \Gr6v I ❑'-�Sain L,` ❑ Clay Loam 0 Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date -----......... .�) No U'New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public suis available.within 200 feet.) Septic Tank: Distance from nearest well-/-L4_........Distance from foundation.. ......-_.Material.... _____________________________ �f No. of compartments-------- --------------Size.............f-- -:, `` Liquid�dep, h____-____--"___--___-_--_-Capacity�L�D Disposal Field: Distance from nearest well./#?-.`-._.Distance from foundation------ -_---------Distance to nearest lot ❑ Number of lines...................................Length of each line____._.__._.._......__...__._.Width of trench.f��.As ............... L?C>' 4' Type of filter material__._9o� t t___..-.__Depth of filter material..-z Y.............Total length- ................. 11i Seepage Pit: Distance to nearest well------------I---------Distance from foundation--------------------Distance to nearest lot line_________-____-__ ❑ Number of pits......-_-_•----------Lining material-----------------------Size : Diameter-----------------------Depth-----------------------------.-.. ! *, Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material...,..------------------------------- � ElDiameter•----_------------------- ---------Depth----•---•-----------------------------------•-••--•-Liquid Capacity---------------------------- Distance from nearest well...._-------------______ -_--_-"--.-___-_ a ----Distnce from nearest building------------------------------------------ ❑ Distance to nearest lot line✓_................._/-••-------------------------- ......._._..----------------------------------...... .....-._... Remodeling and/or repairing (describe):-----------i -----•-----• I --------------------------------------•------------------........................................................ 1 VA ------------------------------ -- 11 ,-_-_-_-__----------------------------- ---_ ----------------- ------------------------------------------ I hereby certify that I have prepared this app)ica+ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations df the San Joaquin Local Health District. U (Signed)......... " wT/oN -- _-------------------------- ----------------------- ----------------- ---------• - --------(Owner and/or Contractor) BY= _ �, ion ----------- I•-•-----------------------------------------------------...(T'i+le) (Piot plan, showing size oys+am in i relation to wells, buildings, etc., can be placed on reverse side). FOR D P USE ONLY APPLICATION ACCEPTED BY-- "___._-_- _ ________________-..-DAT-E.......6..:4� �,r i: .::. REVIEWEDBY--------------------------------------- •---- -----------------------•--------------------- ................................. DATE...........----------------- •------------- BUILDING PERMIT ISSUED-------------- ..............................................._......................_.-•---_---._. DATE--------------------------------------------- - AFterations and/or recommendations:-------------------------------------------------•--•----_-__------------___---------------••--------------------•-••---•-----_------•------------------------ •-•------_"-_._____---- --- -- ........................"_...............----•--..__..._..._._.__._...-.................................................................. {� . �� ..._..; .---- 1. -�----- •------------------------------------------------------------------- ................. ............. ................... ...................... ..........--- ---- -•---------------------..... ------------------------------------- -- - ------ ----------------.-._._...._._._._...__.._.....------------------------------------------.-.._.---------------------"--------...---------_..---.....------------ 1 FINAL INSPECTION BY - ... .. ..... Date--------•- �fl-•-y f 7 ... ,;ASAN:JO AQUIN LOCAL HEALTH DISTRICT ��I � 130 South American Street 300 West Oak Strut 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-99 2M 9-62 ATLA9