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FOR OFFICE � Permit No. .. _..//. - •� -_� - .� _ ,- APPLICATION FOR SANITATION PERMI l�?. ....... -------------.� -----1/___-- jComplete in Duplicate) Date issued ---.41 ----------------------- ---- ---------- ----------------- " This Permit.Ex ires 1 Year from Date Issued s Application is hereby made to the San Joaquin Local Healfh'District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. P Man Dft JOB ADDRESS AND LOCATION-------�e 4f] --------a��.0 ----..� -----------------------;......S ----------- Owner's Name......476f�,E--.�1l�----------...-4 .1.7~� lei-----_------------- --------------------------------------------- Address_ •----------------- Phone. _� •� ---- =� f'---------------------------- -----••------•----------------------•-----------------....-•----..... N* , Address.-•---------- -------------------•-----...-----•---------------- -- - Contractors Name-------- ._ 1_�Z.-h . SP /-N _ Phone.&P_-6.2-!a c7 7_--_ Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ i Number of living units: --- Number of bedrooms - __. Number of baths -_l___ Lot size -----------• --•--•-- � 't Water Supply: Public system ❑ Community system ❑ Private Z] Depth To Water Table `X?!- ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam I] Clay ❑ AdobeRl Hardpan ❑ V, ___) No ® New Construction: Yes Previous Application Made: (If yes;date----------------- ❑ No W FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: O► (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q s Septic Tank. Distance from nearest well____-------------Distance from foundation------.-------------Material------------------------------------------------- ❑ u' No. of compartments--------------- ----------Size--•------- ---------------------Liquid depth Capauty -- Disposal Field: Distance from nearest well__�s1_........Distance from foundation__.74 ..........Distance to nearest lot line..___`S.-__----. l ® Number of lines-----------./----------------;---M-Length of each line----- p0- -----------Width of trench---------- - Type of filter material._RP-5'�.%<-------Depth of filter material----._l ~-_.--Total length_-_____---fQ�_____•-------••---- Seepage Pit: Distance to nearest wekl__-_1p�._�_-.-_Distance from foundation---AS .._...Distance to nearest lot line-----3___.-__-. ® Number of pits--------- ----------•Lining Size: Diameter-------- Depth-------- ----------- Cesspool: Distance from nearest well_______________-Distance from foundation__.__--------------- material___---______-_____. ----•-----ga.Is. Size: Diameter--------------------------------------Depth-----------•----------------------- *---------------Liquid Capacity----------•------------- 9 ____----'_____________ __-_Distance from nearest building------------------------------------------ Privy: Distance from nearest well Distanceto nearest lot line ---------------------------------'=-'------•--------------•-----•------------------•- -------------------------------------------------- Remodeling -------------•----------------------------------Remodeling and/or repairing (describe):__._,oVZ?4>------T�/�9/�lt`t2�'�--------........ (2.---------•----..... ---------------------------------------------------. --------._------------------------------------------------ --.--------------------------------------------------------- •----•------------------------------------------------------------------------------------ _ _ -- --------------------------------- ----------------------- ...........-------------------------------------- -------- _-1 hereby certify that 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. Owner and/or Contractor (Signed - ----`�-J--=- �'---�� --=-------- ----------------------------- - { By:....---, I `_ (Title)---- ------- �- {Plot plan, showing size of lot, Iota ion - system in relation to wells, buildings, etc., can be placed an reverse side). FOR D PARTMENT USE ONLY / APPLICATION ACCEPTED BY`�._-.- ----�- -- -- - --------------- --------------------------- DATE_A�- - Z•J---------------------------- REVIEWED BY---_-------------------------------------- . ••• DATE----------------• ---------------------------------------- ---- r BUILDING PERMIT ISSUED---_----_------------ -- i DATE---------- -- -•-------- ......----------------------•- �.. - Alterati s and/or race mendationr..___ ' I ---------------------------------------- _ ._. ----------------•----------------•------ ------------•----•-------•---- --- --------------------------------------------- ------I------------ ----------- ------- ------------------------ -------- ----------- _ 2 .r FINAL INSPECTION ' Date_ �LL ... S N JOAQUlN CAL H ALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,Californias ES 9 REVISEQ 8.59 2M 5-62 ATLA5