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FOR OFFICE USE: ----------------- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . ! ... ._3.. --------- ------ ------------------------ --------------- (Complete in Duplicate) ----- This Permit Expires 1 Year From Date Issued 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. 549. JOB ADDRESS AND LOCATION........ .. . ......... v� - - ------ ------ Owner's Name... d� ?... - -rs. ................----•------ �`-��` - Phongl�_. ��-�� Address.. ----------.. g .... ---------------•--------------------•-----------•--••-------------- Contractor's Name..................... -. ------ .------- Phone -----------•------•--------- Installation will serve: Residence 0--A_�artmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---oo'__ Number of bedrooms __Y Number of baths ____!_ Lot size --------- _X_ :X Water Supply: Public system ❑ Community system ❑ Private []Depth To 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 0 New Construction: Yes ❑ No [3---FHA/VA- Yes ❑ No-El— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----`zrr..I istance from foundation____-_-e'i5 ____Material_____L ❑� No. of compartments___.__._2.�-_-___.___Size------ ---X v_=Liquid depth-_.____y-------------Capacity-_____._ c? � Disposal Field: Distance from nearest well-_°2 q?._Disfance from foundation___1_5_-._ ____.Distance to nearest lot line....." ._C'_. i ® Number of lines_______________� ____Length of each line--------cr__��__----------Width of trench___.___...:__ ----------- ii W Type of filter material. _.-!"=�C_Y_-.Depth of filter matenal--��-------..-_Tofal fang+h------=-------------� --...------- Seepage Pit: Distance to nearest well---- �_ __-Distance fpm foundation____ � _.Distance to nearest lot line...... _ p Z_ J .16 fN Number of pits-------- ----------Lining material-__:--------- _c._--.Size: Diameter_._�K,?---_____---,De th-------•-----:=----•----•--__---- iCesspool: **%Distance from nearest well-----------------Distance from foundation--------------------Lining material------..__---------------_--------... ❑ SzeDiameter Depth Liquid Capacity gals. Privy: Distance from nearest well-----------------------______________j------....Distance from nearest building ❑ Distance to nearest lot line------- ------- -------•---------------•--------------••------------------' Remodeling and° or r# airing desc ---� I g �, p g { --- = -a --------.. - {y/ ==' •------------ .------ a+� -- --------------- - --..--•- ------------ ,� �. _._.. - f I hereby certify thaf,I have 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 District. I (Signed)_- 57.-"��- ..Z -�-�- ---------------------------------------------------------•----(Owner and/or Contractor) BY: -------------------••-------- -----------------------------------------•-------------------------------(rifle)-----------------•---------------------- --------- (Piot plan, showing size of lot,location of system in relation to wells, buildings, etc., can be placed on reverse side). r- - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_'_$`r_ r--=t� 7----------------------------- - ----------- DATE.-----'-_-•o,,_--J REVIEWED BY---------�---------- ; ------- - - �.�_..---------•:--=--�_. - --- -------------------------------------------------------------------- -. DATE BUILDING PERMIT ISSU•ED_��', tx`\ --------------------------------------------- ----------•----------- DATE. Alterat" ns a or recom ndations:__----- ---------- --- ---__-_---_-_•,----___-_---------_ .. _ . .� --------- - ------------- •---------------------- I FINAL INSPECTION BY:. Date Z-O 6� SAN,'JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street — 300 Wist Odk Street T 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,Call formic Manteca,California Tracy,California ES 9 REVISE[] 8.59 2M 5-62 ATLAS I i