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FOR OFFIC USE: � I APPLICATION FOR SANITATION PERMIT Per -- ---------------- [Complete in Duplicate) Date Issued --- - •- ------------------------ - This Permit Ex fres 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construc nd ' all the work herein described. This application is made in compliance with County Ordin ce No. S49. - - = JOB ADDRESS A OCATION = -f---------------- Owner s Name. 1 440. _ t Address p _-- -- ------------ rContractor's Name--• --------- -----------------------------------------•----•--•---......--- Phone----------------------------------- Installation will.serve: Residence'�Apartment House ❑ Commercial ❑ Trailer Court C] Motel ❑. Other ❑ . Wik ' Number of living units "" __ Number of bedrooms - r�___- Number of baths /... Lot size . }�- ••106.... .......................... SP 00, Water Supply: Public system Communify system C] Private C] Depth,TO Water Table 40- ft. Character of soil to a depth of 3-feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam [I Clay E] Character erdpan [3 Previous Application Made: (if yes,date-.._____----_.__._} No New Construction: Yes �ro C] FHA/VR: Yes *No 0 3 ; l TYPE OF ,INSTALLATION AND SPECIFICATIONS: 1 j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Ai+ `_ r ' Septic T k: Distance from nearest well_____7__._Distance fro foundation_, ____..___.M to ial__�jr_u" ;�; J Ca acid No_ of compartments_""-- . .. Siz �? Liquid depth__-- -- .----" p ty__ _____ ________"- Disposal Field: Distance from nearest well-._.~`----Distance from foundation__-APr-----.Distance to neaiest lot line.0------------ Len Length of each line__ Width of trench-- -------------•------------- Number of lines_'.__ ��.- �j- 9 -�- - --•"""""-""" i Type of filter material. - p Total len th____.� -- Depth of filter materiae---�f---.- 9 Seepage - Distance to nearest well_____�y______Distance fr�_fo dation__.. __.___.Distpov to nearest lor�t Ike___ ____________ (� 801- Number of pits__._IZ Lining material._I� .Size: Diameter_,` Depth_-R�r�� i Cesspool: Distance from nearest well-----------------Distance from foundation-----------.--------Lining material_._..__-...___ __.__.__________-- ❑, {Size: Diameter------•--------------- - Depth _ _ _ =` l iquitl map ca itY-------------------- -------gals. - Privy: Distance from nearest well-------------------------------------------------Dia arrce from nearest building--------------------------------------- ---------- ❑ Distance to nearest lot line------------ ---------------------------- �,.,. and or re airin describe : __.--_"- - = --••------------------------P g � � - - ----4- Remodeling--- ------...-•----------------•------- -----------------•-------•------ t ----------------•------------------- •--- -- -------• ------ •-•-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State lawWan 'jruland regulations f the San Joaquin Local Health District. --- -.( 9 )--- ----------------- ---- . ---•- t ---.(Title)---- i (Plot plan, showing size cf lot, location of system in relati o wells buildings, etc., can be placed on reverse side). ---'"� -- - -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---- ---- - ---------•--------------------------- ------- DATE.-- r 'Lv.- -- --------- REVIEWED BY---------------------------------- DATE BUILDING PERMIT ISSUED------- ------- --- ------------• DATE....... -------------------------------- -------------------- Alterations and/or recomm.nd'ations:_.___-.._ � _� - ----------------------- n ------------------------ --- ---- --------------- ------------- --------------- ----- -------------------------- ------------------------------ ---- ___r_._` ----------------------------------------------------- Date_. ---.-• 1----- ----------------------------- FINAL INSPECTION BY•/_.�....."-__. .._ � --- --------------------------------------- SAN JOAQUIN_ LOCAL HEALTH DISTRICT ' }30 South A ascan 51reet .�, -'300 1Ne�t Oak Srriit 1.�,5-.y _ 24.Sycam;4 11reet l �3 105 watt 91h Street f I `. Stockton,California Lodi,California Manteca,California Tracy,California M� E5 9 REVISED 8-59 2M 5-6Z ATLAS