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FOR OFIF�E U E: els►► �. r '-- -------------- i��.)S�h APPLICATION FOR SANITATION PERMIT Permit No. . (Complete in Duplicate) Date Issued _____________________________ This Permit Expires 1 Year From Date Issued .____...�... .. � 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 County Ordinance No. S49. JOB ADDRESS A D LOCATIO -- ___-- �ta°�,.� ?� --... .. 'I— ---------••-------•-----------------------•-------------------•---- it Owner's Name-- 'f . ' ' Phone...1440_. - - -..... Address__... .. _. ...•- ----•-•-----.... —.. == •-------- Contractor's Name----( 4...... L,e,��Et . Phone.--.-._•---------------- Installation will serve: Residence ❑ -Apartment House ❑ Commercial ❑ Trailer Court 10 Motel ❑ Other ❑ Number of living units: ._... Nu ber of bedrooms __7____ Number of baths --•#-__ Lot size ...._j _.--?4___. _ •_._._.-.-._____._ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table . ft: '1' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay C9_.,-Xdobe❑ Hardpan .� Previous Application Made: (If yes,date--------------------) No B--�New Construction: Yes g--rqo—❑ FHA/VA: Yes ❑ No [ems TYPE OF INSTALLATION AND SPECIFICATIONS: O A'4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance.from neares well__Distance f�m fo inda i n-�_%t_d.__.:..._..MatHr _-_l�-s� .G`r&- No. of com artmenfis__________________________Size._._ X�__Li 'i e th- _�f Ir , Ca ati l 50. If iP �. q P. �� ...- : P tY--•- Disposal Field: Distance from nearest.well""- __Distance from foundation-40 -r�i�Qs_Distante to nearest lot line....l.�....... P Number of lines-------257____ ___Length of each liner-x_70;)__OWWdth of trench:......... .............. Type of filter:,ifiatenal-.._ .p.C-K__.Depth of filter material:__.1.ry..___ .._."Total t� • Seepage Pit: Distance.to nearest well_______�istance from foundation___________________.Distance to nearest lot line_,��_.___.__._ i'. Number of-pits......... _. ___Lining material___:A. - ___Size: Diameter---- S_"---------Dept h------ .................. Cesspool: Distance from.nearest well----------------_Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter--------- - f------------------Depth--------------------------------------------------•.Liquid Capacity ----....,.........------.gals. Privy: Distance from-nearest well----------------------------------------------- Distance from nearest,building____-_____.-_-___--_____-_._____,._______- ❑ Distance to nearest lot line. -• ----------------------=- ------ } Remodeling and/or repairing (describe):.------- ---•-•------------------------------------•------------------------•---------•--•------•-------•--------------------•-•--------•--••-------•---- -•-----••--------•............................................,-"_---•--•---•....--------•----•---...--•----•--------------•-----------------------------•----------•-•------------•=----•-------------------------•-------- ----------------------•--------------------------•-•-••------••-----------------------------------------•-------------------------------------.------------------------------.•--------.--.-------•----------.------------.--- I hereby certify that I have prepared this application and that the work will be done in accordance-with San Joaquin County r. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. St ned -� -- - ------------------- - ----- ---- ••-------- -------Owner and or Contractor 9 - -- -- - - By---X-- 1.41 a v....---- C '' {Title)-----------= ---------------------- ......... -- - (Plot plan, showing size of lot, location of system in relafi! to wells, buildings, etc., can be placed.on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- = -------------------------------------------------- DATE--- ------------------------ REVIEWED-BY---------------------------- --------------------REVIEWED`BY------------------------------ -------- — •---•---•-------------------------------------------------•--• DATE----------------------------------------•--••----•--------- �. BUILDING PERMIT ISSUED .-.-------- — DATE E Alterations and/or recomm_a dations:-_-------"-_--- -... `--------- -------------------- -------.---- v . ' ----------r-----"-...__ _ *` ----•------------------- -•-- -- -----------------------�------._.... �. ------- c I FINAL INSPECTION BY:._- � date_._..____. w AAKQ IN LOCAL HEALTH DISTRICT 130 South American Street 300 West oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Yraw,California I EE 9 REVISED B-59 2M 5^61 ATLAS t '