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fOR OFFICE USE: — - : � wy - ---- -- R APPLICATION FOR SANITATION PERMIT Permit No. (. - ..�. (Complete in Duplicate) I A lica+ion is hereby made . the Sen This Permit Expires ] Year From Date Issued Date Issued .. ¢.. _.�..._. �— PP Joaquin Local Health District for a permit to construct and install the work herein described. This application is, made in t6'mphance'with County Ordinance No. 49. ]. •, JOB ADDRESS AND LOCATION:_.q. Owner's Name__.__ ----- --•------•• ----•- •- ---•--------- ------•-------------------•-------•-••--------- OX Address__.... -------- Phone Contractor's Name__________________ P ,. Installation will serve: Residence 'A artment House ❑ --Commercial-----------------••---'-- •-----•----•--•-•--•--- Phone................................... ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _/-_ Number of bedrooms -_�-- Number of baths .I... Lot size _ �--,-•- .- _ �......................... Water Supply: Public system �Conrmunit s stem �� Y Y '� Priva to ❑ r.Depth:ro -Wafer-Table, Character of soil to a depth of 3 fee+: Siad❑,_Gravel'n-•Sand Loam 0,.�,�.-- Y" ❑ "Clay foam.[ .,.Clay_❑Adobe Hardpan ❑ Previous Application Made: (If yes,date._-__._----_------------) No TYPE OF INSTALLATION AND SPECIFICATIONS: C��New Construction: Yes L] No [B'FHf# 1IA: Yes ElNo �} I (No septic tank or cesspool permitted if public sewer is available within 200 feet.] �.. , Septic Tank: Distance from nearest well _ _Distance f om foundation__/O------__-.Matal� �ea -. '��' No. of compart*n#s_.- j----------- $ixe- ii_ .W - -• --- --------- �" -- Liquid depth----- � -Ca act Disposal Field: Distance from nearest well._ ---- `' P tyg��--•'--.... _- ---__Distanced from foundation.- el -----•Distance +o nearest lot line-tr./ Q� Number of lines----- ' .__....-- a, -------- ------ --- ength`'of each fine-----_t�---------------Width of trench-_�__�f..___-•---- --_-•-- Type of filter material.��_ £pth of filter material----.-_-moi Seepage Pit: Dis#ante to nearest well--------------- Total length----- Seepage fr fou dation__..s47�•-Di to c to nearest lot line_. Number of::pit -------------Lining material._ }}�� / tf � .l .Size: Diameter__._ .------De th Cess ool: p ��-------------•----- � ❑P Distance from nearest well-________________Distance from foundation`�.�. _ dining materiel__.-._ Size: Diameter-------------------•--------_- F -__.._---_._ ------Depth------ •----------------------•-Liquid Capacity gals 9 j Privy: Distance from nearest well-___ -- ------_ ----------------_-_____--.___Distance from nearest building L1l r g ---------- ❑ Distance tfo�nearest lot line--------------------------- Remodeling and/or repairing(describe): � __ ---------------------- ----------------_---•------------- ---- -- --- --- --•---- ------•------ ---------`----------•-p----•9•--------- ------•-------------- -------------------------------------------------------------- ------------------ ------•---------------- I herebycertifythat I have prepared this application.,and that +he work will be done in accordance with San Joaquin Coun P ordinances, State laws, and ules-and�e ula+'ons of the San Joaquin Local Health District. Y = I (Signed) By:----------------`'-`----------------``- i � Contract -- ---- ---------- g r Titl P (Plot plan, showing size of lot, location of system in r on to wells, buildings. etc., can(be ]laceeverse ). ` ' f DEPARTMENT USE ONLY a APPLICATION ACCEPTED -BY------ -------- REVIEWED BY.... .:_ T r `# ----------------------- ----------------- DATE--------1 .!i!— -- ---------------------------------------- DATE......... --------------------- AlterDat oG anR/orTrecommr n , ° l ,/ SUED �i ---------------------------------------------- ------ dY r - r A ions:-------------- ----------------•------------- ...'--•.... ------___..._---•-•... \. . �r. --•--------•---------- -----------------------•----•------•----•--••---•----••- ---rf crl�. ------------ Cy ------ ------------------ _ = 1- -—--- -- S- '—� 1 . 4....__l15--------••---'---------- --------•-------------- FINAL INSPECTION BY___________------ --------------------------------------------- `SAN JOAQUIN1OCAL HEALTH DISTRICT 130 South American Street * ' • " 300 West Oak Street a 124 sycamore Street�~F ` 1 Stockton,California Lodi;California 205 West 9th Street Manteca,California � ES 9 REVISED 8-54 FM 5-62 ATLAS Tracy,California� �.