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FOR OFFICE USE: rp .30 ---------------- APPLICATION FSR SANITATION PERMIT Permit No. .I�/_........ -- -- - -- - -- ------------------------------------------------ ---- --- (Complete in Duplicate) 6 ------ --- This Permit Expires 1 Year From Date Issued Date Issued .__._ ._7_._ 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 compliance with JCounty Ordinance No. 549. JOB ADDRESS AN CATIO .....X1 --L7.- F -..... ,-----------------------•------•-••------------------------•------------------------•-- Owner's Name....... - ---- `' ' -------------------------------------------- Phone-------------------------............................... Address..........------- ~ 's Name...Contractor4 ��-----•-------••----••--•----•---•-----•-••------•----•------••------•--- Phone.................................. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / e Number of living units: ..!._ Number of bedrooms - ._ Number of baths -------- Lot size .._ . 0--j/ .................................. Water Supply: Public system 0---C,ommunity system ❑ Private ❑ Depth TO Water Table .,'f tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe <ardpan ❑ Previous Application Made: (If yes,date-------- -----------) No g3r"' New Construction: Yes ❑ No 2- FHA/VA. Yes ❑ No 9�,— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se 'c Tan : ,> Distance from nearest well-----------------Distance from foundation-------------------Material_.------------- .._______._-•-______-__.-___-. " ,j No, of compartments--------------------------Size-------------------------------Liquid depth-----=--------- -------.-Capacity---------------------- Disposal Field Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. C= 1Number of lines-----------------------------------Length of each line------------------------------Width of trench................................... �� Type of filter material- ----------------------Depth of filter material---------------------Total length...-..--------------.---------------_---.- S Distance to nearest well------_ "y.-----Distance f�m�fundation---,�G`�� ....Distance to nearest lot line_47___._- Number of pits___ ______________Lining material. fid. .- __..Size: Diameter-- --------� Depth__�.4�7e----------------- Cess dry Distance from nearest well-----------------Distance from foundation--------------------Lining material____.______.____-_____-__-_---_---_- Q ❑ Size: Diameter_. Capacity---------------------------- \ , Privy: Distance from nearest well-----------------------------------------_-------Distance from nearest building._____.___----_-.__-•_-______._________-- V ❑ Distance to nearest lot line----------------------------------- ----------------------------------......-----••--------------------------------------------------------- ------- Remodeling and/or repairing (describe):------------- _- - .a- f' ------------------------------------ ---------------------•---------------------------------------------------------------------------------------------------------- ----------------...------------------------------------- I 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) ' 9 ) mac ? --------------------------------------(G*jnw-4wai�ar Contractor] B :..................... ... . .. Ti+le Y ' ----{ ) '----------------- -------------- (Plot plan, showing size of lot, location of system in relati916-40wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------------------------------------------------- .........._ DATE----- ------•--- --------------- REVIEWFD..BY-------- ----- --- --------------------------------------.._..---------. -...---- --------------- DATE------------------------------------- -------------------- BUILDINGPERMIT ISSUED-----------------------------------------------------------------•--- -••---------------------------- DATE------------------------------------ ------ Alterations and/or recommend'ations---------------------------------------------------------------------------------- G = -- - --------- ----�---•---•-•------------- ------......-..-....-•-----...-`�----------•-••----••---------- //�� --yy •--•-• --//-��-- -----'-----------`---------Cd-r- •T_.lD ..--.._.,r.__� _.r._�.`.reLS��_ -r!�;4_R - - - - . -------------------•------••------------------`_F' - - C.<_��_..--------------------------------------.---_------••-----------------------.-- ---------••------------------------ - t7-- - FINAL INSPECTION BY:. = ` c ------------•----------•----- Date...... -�.� ------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT .f 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lad],California Manteca,California Tracy,California ES 9 REVISED a-99 2M 5-62 ATLAS