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FOR OFFICE USE: ------------- ----- --- _- ------------------- APPLICATION FOR SANITATION PERMIT---------------- ----- Permit No. .. +---'-- �- ---- -- - ------- (ComplataTin-Duplicate) •--� - .. l 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 install the work herein descri This applicationJs made in compliance with County Ordinance No. 549. bed. JOB ADDRESS AND LOCATION 3. 1 `5 C�� + INeo . ,. Owner's•Name---- .t ..e_ !. ; • .. . ��•j• -0,-4-�y--- -- Phon d'd' ----=-----------------•----------- sfr�l�: _ p Address--,•---•-•••--•----� -.j.4. _?? -----------------------------------------------------. ------------•-- ---------• -................................ Contractor's Name---------- .�-: .•___ t�.! .t't/sS/?r S�^/S H 60.2 -� -- -----• .. �-..----- Phones _ ... Installation will"serve: Residence_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of iving units,0-1- Number of bedrooms -..3_.- Number of baths -2--. Lot size _.5 ' X____/_�1� _'-_••_-•-•-__ Water Supply: Public system;Er"'Community system ❑ Private ❑ Depth To Water Table AQ. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe Hardpan ❑` k Previous Application Made: (If yes date....................) No [ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION•AND SPECIFICATIONS: (No septic tank o� cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well................Distance from foundation--._........._------Material ❑ No. of compartments--------------------------Sjz'e------------------------------ Liquid depth--------------------------Capacity Disposal Field: Distance from nearest wellWeA/iFDistance from foundation...JO-*---------Distance to nearest lot line------C�_-__ ® C-)057"44 Number of lines-..._-.._./----------------------Length of each line----------- ..........Width of french-------.-ZJ '----------- APID Type,of.:filter.material.29kC—S/K-------,-Depth of filter material.._''- `_-------Total length-------------XI..------------ �: Seepage Pit: Distance to nearest well._„VG_WA-F___Distance from foundation-._/ Distance to nearest lot line•----- �XLS r IN6 Number of Pits.....-../-------- -.Lining material.-.�G'�X---"Size: Dia J! r �s -------- Dept h...........42'r-..-------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-_..........._-......._ ❑ Size: Diameter--------------------------------------Depth--------------------------------------- e a� k Liquid Capacity------------- ---------------gals. Privy: Distance from nearest well. _-- ---- ------------ ................ ...Distance from nearest building-----------------.------------ Distance to nearest loft line--------------- �. , Remodeling and/or repairing (describe:------- fl>. -------7 ----- X3i_/./±ll�-----5 t'STZ=ham ► ..----------------------------- -------•------•-----------•-------•-------------------•-------•--- •----------------••-------•-------•--- ---------------•- --- - -------------------•--------=. ----------,......----------••---------------------------------------------•-------------------------•--------•-•-----------•-•----•---•----.._..----------------•---------------- hereby certify that 1 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. (5i ned 9 )-•------- -- i /sS`/ - -----/------ /Y ------- ---------------------- ---(Owner and/or Contractor) By: rtle. ---- [ ) =------------------- - (Plot plan, showing size of lot, locati n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---. DATE_. )�-`---G---'"-- - REVIEWED BY -- --------- ------ DATE -' - BUILDING PERMIT ISSUED------------ A�erations and/or.re, mmgndations:.- _----- - ATE 1 - ----••--------------•----- �---------- � --------------------- -------- -----•---- ----- .7 ... -------------------------------- ------ ------------------------------------------- FINAL INSPECTION BY:..- Date...�_l.._'- ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,Califoniia Manteca,California Tracy,California ES 9 REVISED 6.59 2M 5-62 ATLAS