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FO OFFICE l� { ✓` -- - -:------ ----%/t-` APPLICATI FOR SANITATION PERMIT Permit No. ----- . . _ (Complete in Duplicate) S -- ----------------- �fpy - . -------------------- -------------------------------------- This Permit Expires f Year From Date Issued Date Issued - - Application is hereby made-to the San Joaquin Local Health District for a permit toconstructand install the work herein described. This application is made in compliance with County Ordinance No. 549. la��`r�"�a�•1� '-x.� JOB ADDRESS AN LOCATION----- '- -1�----- l ��.i�.._ �-�-K l.. - ��j`��---------��- "`vs? Owners Name �.. k f =`r` -------------------------- Address............. ---- ---- •- ----- -- Phone f/ n � / Address rLn �' fr- C !1�'�12.� 1 .. -------------------•-•- Contractor's Name.. EYP.. ..... l'� '` r -rn E�12 � � s rz._ Phone --------------------------- t Installation will serve: Residence E] Apartment House E] Commercial E] M Trailer Court �Motel ❑ Other ❑ Number of living units: :5' 7Number of bedrooms -------- Number of baths ........ 'Lot size _______________________________•.-----_-___-____.__-______-- Water Supply: Public system ❑ Community system ❑ Private ® Depth ro Water Table -------- ft. Character of soil to a depth of 3 feet: Sand,`❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O'�,Hardpan ❑ Previous Application Made: (If yes,dote--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ ` TYPE OF INSTALLATION AND 'SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r r SepticZT'ank: Distance from nearestjwell______--" ..Distance from foundation-----Ir.......Material......... i , ❑ No. of compartmenfis------.-s--------------Size#Y72(.W--X---�--Liquid depfh---'_*_i-------------Ca aci ,r' car,/" c ., I Disposal Field: Distance from nearest well_:_.-5 __._Oistance from foundation----/0_..........Distance to nearest lot line............ Number of lines......_._�f......`------_------Length of each line------f4.�___.. ........Width of french----- ................ Type f4 XX2_Depth of filter material------�_fr__-----------TotaI length_.-..�� r Seepage Pit: Distance to nearest lwell______f `-_Y�_f rDistance`from foundation_-__/_�______-.Distance to nearest lot line---1�_______- . Number of pits------- Lining Material„/ .'k-___.Size: Diameter____. 'f"-----Depth__.................. Cesspool: Distance from. nearest well____.`______.--Distance from foundation--------------------Lining material__._____.__.________________.___.___. ❑ Size: Diameter-- ------------------------ ----Depth.---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------ --------------------------------------______Distance from nearest building.____...______________________._____.._._. ❑ Distance to nearest lot line----------------I---------------------------------------------------------------------------------------------------------------------------- Remodeling ,and/or repairing (describe ___________________ _______________ ---•------------------------------------ L __________________________________________________________________________________-------------------------------------------------------------------------------------------------------------------------------------------- ------------------- -- _. - * 1 hereby certify.that I have prepared this application and that the work will be done in accordance with San Joaquin County. ordinances, Stat laws, and rules and regulations„ of the-San J aquin Local Health District. I :,_1_ fr ._------- ----------- - � fZ /! _ er and/or Contractor r - - ---- ---- --- --- '- ---------------____------------- -----.-...__.. (Signed) j� / ) f �`-1f- : _ sc-— --- - - --- Title By:-------- ��y> — -------------- --► -,� (rifle) (Plot plan, showing sire of lot, location of system in relation o wells`, 'buildings, etc., can be placed on reverse side). �FORtiDEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ _. o ^ DATE I�� _ REVIEWEDBY------------------------------------------ ------ -- --- ------- ------------------ --------------------- ----- DATE------------------------------------------------------------ ING AlterDations and/or TrecSmmD mations:.. r `---T'�'---•--lam” '� f Ste- - ---- t � ,� �' ..: -AVS , } .L.. jG'----G``---.` ------`-- ---- - --------- - --ms=s-�----- �, `�,---, s FINAL INSPECTION BY: /�ot��_.. Date-------- `- -- ---------------------- i ----- "; SAN JOAQUIN LOCAL: HEALTH DISTRICT 1.30 South American Street 300 West Oak Sir*of 124.Sycomore Street 205 West 9th Strout Stockton,California ,Lodi,California Manteca,California Tracy,California ES 9 REVISED e•59 2M 5-62 ATLAS