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FOR OFFICE USE: V . -- -----:------(---�_ _.. APPLICATION FOR SANITATION PERMIT Permit No. _. l S_......� f II (Complete in Duplicate) �I --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued -_.03. i 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. 549. 7 JOB ADDRESS A LOCI W_%; ..................----•• ------ ............................... .f Owner's Name__ -��-----• ,- .� ----- ••------ - •-•----...---- •---- -- -- ------------ -------------------- --------------------- Phone..--•I�---------•-•----..-•......... II Address......._.............. .......... ......... ----------•------------ -- ..r I Contractor's Name-------...... -•- - - ------ Phone.....1......... i Installation will serve: Residence M-_-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _ XN mber of bedrom ___ Number of�� � g •I �� V ',�/ 'baths _� Lot size- 'I ----�p�-�� Water Supply: Public system ❑ . Community system ❑ Private �epth To Water Table ft. r fCharacter of soil to a depth of 3,feet: /Sand ❑ Gravel;❑ Sandy Loam E] C16 Loam ❑ Clay ❑ Adobe 9---gardpan ❑ ' Previous Application Madill:(If yes�daie- __) No J2-" New Construction: Yes �Vo ❑ FHA/VA, Yes g5-''No ❑ [ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or c. spool permitted if public s�wer is available within 200 feet.) f , 7 Septic Tank: Distant I from nearest we . P__._Distan V.om f ndation__��. ee Materi _Gr� No. of Iompartments_`, --------__-'---5ize± __ rquid depth-----��-------------Capcity_fi��------ I Disposal Field: Distance.from nearest well_. _______.Distance'�to nearest lot line__e' ________._ _____..._Distance from foundati Number lof lines_______.��..._..._ _ . Length of each line____ __� Width of trench__ ________________________ Type of;filter.material�� ,/�jDepth of filter material____A�-------------Total length----- :. _ __• ..................... Seepage Pit: `` i Distance to nearest well_-_-f��_(__Distance fr fou ation_ f�._.._._.D'stance to nearesth lot line________._ Numberl'of pits___..__________Lining rryaterial._._ _ n _ -Size: Diameter__-%,! ---___Depth --••------------- Cesspool: Distance from nearest well......._-------).Distance from foundation--------------------Lining material__-._- --------------------------- i ._ ❑ pr _t&epth--------------------- ---------•------------------.Liquid Capacity---�M-•--•---•-•-------••..gals. Privy: Distance fromnearest well_____.___-____ - ---=-`------------------------Distance from nearest building----------�1--------------•---------___--. ❑ Distance to nearest,lot line"----------- t -----------•--•--- •................... ......I....................................-••..•--..._..__..._..._. Remodelin and/or re airinl desc�i '' -------------------- -------- hereby certify that I Kaye 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 Disfrict. (Signed) .......... /� - �' ------------------------- ----- . Contrac+or) BY:................. -I ---- •---•• (Title) %I� ..... (Plot plan. showing s4e of lot, location of system ' ion toiw.ells, buildings, etc., can be placed on reverse side). � dl ,I. °'- FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED: BY----- -- --••--------------•------. -------- . - ---- ��._Z ---------------- REVIEWED BY__...-.--_--------- DATE �� J BUILDING PERMIT ISSUED`--------------------------------------------------------------------------- ------------------------ DATE-------------------------------M----------------------------- Alf, ions and/or recommendations:----•-- -- - -------------------------------•---•--•- ----------•---••--------•-... ..............-----•-----....-M----•-•--------•-------------- �M --------------------------- --. -------------------------------------- ----------• - ----•..•----------------------------------------------------------------------------------------------------------------------------------------------------------------------;- ---- --------------------------- ---- --- ----------------------- - - ------------------- ------------------------------------------------------------------------------------------ ---- FINAL INSPECTION BY:.. Date --- Z - - ------ ------------- SAN JOAQUIN'LOCAL HEALTH.°DISTRICT 130 South American Street 300 Wert Oak Svest 134 Sycamore Street 205 Wait 9th Street Stockton,California Lodi,California Manteca,California Tracy,California .11 ES 9 REVISED a-59 2M 5-62 ATLAS