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-------- ----------- _ �7-' r -- APPLICATION FOR SANITATION PERMIT Y Permit No. .,�.- (Complete' in Duplicate) " This Permit Ex fres i Year From Date Issued Date Issued ___... .1` .. Application is hereby made to the San Joaquin Local Heal'h District for a permit to construct and install the wo k herein descrbed. This application is made in compliance with County Ordinance No. 49. !ice a. JOB ADDRESS AND LOCATION___- f`.!� S- f •- - - ' ---� J--.--------� ----•--.Owner's Name---- _CV--------- Address - .__ �;-rte --•-- Address--------- - -� ^ Phone_.. ---------- --- = Contractor's Name /s' - �- = `-' © :. Phone__._... Installation will serve: Residence ❑ Apartment House [:1 Commercial [j Trailer CourtMotel C] Other [] Number of living units: ._ Number of bedrooms _______. Number f baths ___-.--_ Lot size ______________________ Water Supply: Public system ❑ Communitysystem ` Y ❑' Private Depth ro 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 ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATIOk AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) ` { Septic ank: Distance from nearest well---- Distan i from foundation.____l0.__ No. of tom artments_ -Material_____. +- C p ------- ------------Sizek� �170- - 5...Liquid depth_----• - ✓, � Crq Ee -=--------- ----Ca aci Dispos geld: Distance from nearest well---- -.=--Distance from foundation_.__1.L3..........Distance to nearest lot line__Number of of lines_-_____1�1k._-.--_-__"-_---- Length of each line----- p+5___`.__ fl-------Width of �-_ Type of filter material._.,, -;JIFF Depth of filter material----- _ -----.Total length____ t� ------------------------- A_ -T _---------� Seepag it: Distance to nearest well__ 0--`�---__Distance from foundation____- L i �� J�_..:._.__.Dista`e to nearest lot line__- Number 6f-pits----- _____---__Lining material_-_ellzw. &Size: Diameter_ . Depth---- fir` Cesspool: Distance from nearest well---------- Distance from foundation._____.__"_______..Lining material______________________________ _ •---- P --------------- •------------------------•---Li Liquid Capacity l . - q P t1'- ----------••--------------gals. v � El Privy: Distance from nearest well__________________ _ _ Size: Iometer------------- "- --• . ❑ Distance to nearest lot line---- ------------------ ----------------------------- •--------------------------------------Distance from nearest building------------•------•-----..:-- •------•--� f� Remodeling and/or repairing (describe)--------- ------•--- - ---•----------------------------•---- -----------------•---------•--•-- ('d --"---•---------- ------------------------•-------•-----_------••-•------------••-------•-•------------------- ----- � hereby certify that I have prepared this application and that a work will be done in accordance with San Joaquin County (� ordinances, State laws, and rules and regulations # the San Joa in Local Health District. (Signed).- '�••°'_ ' ! , By.--.--_-- - /._ --- :--(Owner end/or Contractor) y �J ---- I ------(rile)----•-----�--------•---•-----------•--- --�- �- ------ (Plot plan, showing size of lot, location of system in relation tdlwells, buildings, etc., can be placed on reverse-side-- �� FOR DEPARTMENT USE ONLY �E APPLICATION ACCEPTED BY_. -"---_ _ -_ cam-L� - - ` i DATE f `� ----REVIEWED ` 8Y --------- -------------------------------------------••-------- --. DATE. i BUILDING PERMIT ISSUED--- -=---------- ----- - _ AlFerat n n�_/or recommendations.-_._ °�-��— -- as `" -------------- rr x - ---- -- -------- u �3 - - ----�-----•-•-•- - ---------- ----•-cam_.. +. FINAL INSPECTION BY:..- . - - L I = } Date---------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South AmericanStreet300 West Oak Servet 144 Sycamore Street 205 West 9th Street Stockton,California, Lodi,California - ES 9 REVISED 8-59 2M 5-62 ATLAS Manteca,California Tracy,California �•� t f