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FOR OFFICE USE. l l—rL-1.0 .; APPLICATION FOR SANITATION PERMIT Permit No. .. l. ... �J........ ----- (Complete in Duplicate) � _. +�j� .• s Date Issued ._-_---_---•------ �____________________ This Permit Ex fires 1'Year From Date Issued � - Application is hereby made to the San Joaquin Local He lth District for a permit to construct_and install the work herein described. K Th1s application is made.in compliance_with County Ordinance'No. 549. _OB—AWAND LOCATION ��4 //11_ l -__- Ff ' rT ._f�1liYa--R ----------- --------?Qlf ' ---J'`Ar✓Tiy�" f, Owner's Name_/ ifff !!91A._..t �. .----- • •--- - Phone.,t}�Q_ys�F� sf_.�. Address---.....--�3.!!r........qz-W.!e!Fee,D-----R,Z......................................•----------•.....................-......sS7*eKl..----.......-------•------------•-•-----•---1 Contractor's .................................................................... Phone. W".,efAi6 -..-%t---•. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J... Number of bedrooms `�__ Number of baths _.1.... Lot size ______________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No f?r' FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION-*AND•SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septic Tank: ak: N� Distance from nearest well_________________Distance from foundation____---__•__._---_Material................................................. �. ❑ No. of compartments--------------------------Size---•-----.----------------------Liquid depth--------------------------Capacity....................... Disposal .Field: Distance from nearest well._I��^�-----__Distance from foundation___-__-__.___.Distance to nearest lot line...1P.O...... EKI �fNh Number of lines------------I---------------------Length of each line-------600_f_____-____.Width of trench._.____i�`f_"----------------- Type of filter material._."/ d4 /C____.____Depth of filter material______l ��_______Total length______._� .f....................:.. Seepage Pit: Distance to nearest well----------------------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_______-__-__________________--_-_•_ A ❑ Size. Diameter--------------------------------------Depth-------------------------------------------- •----Liquid Capacity..................... - gals. Privy: i Distance from nearest well------------------------------------------.-----Distance from nearest building.......................................... ± © t Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------._. I Remodeling and/or repairingdescribe):__--_jjAQ__._-_.T�?______- __-----•--_ •_- l -----------------------•---------------•-•--•------•-------------------------------------------•--------------•-----••---•-------------------•-----------------------•--------------------------------- ..............------ t ------------------------------------------------ ...'-•-----..._..:_.--=--------------•-•---------------------•-•----------------------------------------•-••-----------------••------•---------------------------------- 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)- 1�Jr /Q2.l .12! ¢ S'4�,e(/. '-------�/YC ---------------------------------------------------------(Owner and/or Contractor) 4 s ` ��*'•"-2r=------------------------- Title (Plot plan, showing size of lot, locati' of system in relation to wells, buildings, etc., can be placed on.reverse side]. FOR DEPARTMENT USE ONLY : APPLICATION ACCEPTED BY------------ - DATE--------- ,fir -_-, _--- ---- �______._ REVIEWED BY-------------------------- ".---- "/----------- ---------------------------------------------------------------------- DATE------------------------------------•-•-------•----- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------------------------------------....---- Alterations and/or recommendations-----------------------------------------------.-------_.-_-----------------------------------------------------------------------•-•-•----------------------- f ------------------------------------------------ --------------------------------------------------------------------------------------------------•------------.-.._..-----...------------------------------------------ k ti -•---------------------------------- -----------------------------------------------------------------------------------------------•--------•- i FINAL INSPECTION BY:--.................... --------- .-• Date--------------> -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Simet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 0 REVISED S•59 2M 8-61 ATLAS