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%jrri It U 7W------ffA ------------ --------------- --------V .... APPLICATION FOR SANITATION PERMIT Permit No. J...17 7 - --------------------------------------------------------- (Complete in Duplicate) if$f_ Ar -------------------- -------------------------- ------------— This Permit Exeires I Year From Date Issued Date Issued Z�/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal[the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-_--L_..°_._.._..W--, - ---- ------- ------------I-------_-----------_- --••--------------•-•-••-• ....... Owner's Name. ------ ............. ------------------ �------------------------ ----------- Phone...... Address....------- .............................. ---------------- ---------*-------------- ........ .................................................. Contractor's Name----------- i 7 ---__------ Phone................. Installation will serve: Residence Apartment House C] Commercial D Trailer Court E] Motel 0 Other [3 Number of living units: Number of bedrooms .o2_. Number of baths -- . Lot size Water Supply. Public system 94---community system Ej Private El Depth to Water Table V'40"C*ft". Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam [] Clay [:1 Adobe 3--Mardpan 0 Previous Application Made: (If yes,'date__ ------------ -----) No iO--New Construction: Yes [I No �. �A/Vk Yes No 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-----------------Distance from foundation.. -----_-----------Material No. of compartments--------------------------Size-------------------------------Liquid clepth........................ Capacity..................... Disposal Field: Distance from nearest well-_--------- Distance from foundation.... Distance to--nearest lot line...tl? ....... Number of lines_--/-----------------------Length of each line._,2e--- -----------Width of trench. . -------------- Type of filter materiaV�tieP4`sJ�,Depth of-filteF material..__ Total Seepage Pit:: Distance to nearest well______ nearest lot line Number of pits-----Zr-------------Lining materDiameter.- -.Size: -------Dept h---A.�................. L) Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining r.�naterial----------, Size, Diameter__�------4 : I--------------------- ❑ - ----------------------------Depth..--•----------------•-------------------- - --------Liquid Capacity........__.................gals. Privy: Distance from nearest 'well . j . ---------------------:--------------Distance from nearest buitd;ng-------- ----------------------I------ ❑ Distance to nearest lot line ----------------------------------- -------------------------- Remodeling and/or repairing.;(descr'ib6.),:,---------------------- A4101- ---------P ------------- ............. ---------------------------------------- ............ ---------------------------------------------------------- 7� j ---------------------- -----------------------/ ------------------------------------ ........................ ---------------------------------..... :-------------------------- ----------•----------- -------- -I- - -- ----------------------_ ; . ------I------------------- ----------------11-1----------- ------------------- ----------- -----------I...............------------------I------------ -------;------------------- --------------------------------------------- ------------- I 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. (Signed)------------- Iwrr&r-,0NmVor Cap ra for) -------------- -------------------------------- ............. -------------------------------------------- wing size of lot; location of system - ------- --------(Title] -------------------- ...................................... (Plot plan, showing in re wells, buildings, etc., can be placed on 111 reverse-side), FOR DEPARTMENT USE ONLY :APPLICATION...A...C...CEPTED'BY___.._ - ------ ---- --------------- ---------- ---- e -- --------------------- ------------------------------------ - ------------ REVIEWED BY - - ----------------------------------- --------------PERMIT ISSUED_- ,Alterations and/* recommen tions:' --- -------- ... ........... ..... ------ _----------I—........... -----------...... ........................ ------ ---- x�_ .........-------- ----------------------- -----------I-------------------------------------------------- --------------------------I------------------------------------------------------------------ ...-----••---._ ----------il�--------------------- ------ --------- -------------------------- .... ---------I---------------------------------------- -------------------------------------------------I-------------------------------------- ------ --------------------- ----------- ----------- ---------- -------------------------------------------------------- ::--_------------------ -------------------- --------- .......... ........ FINAL INSPECTION ------------------ Date...... SAN JOAQU.K LOCAL,HEALTH DISTRICT 130 South American Street 300 West Oak Srraj, L 124 Syt!rnare Street 205 West 9th Street Stockton,California Loidl,California "fir Cc lforn;a Tracy,California ES 9 REVISED 2.59 2M a-fil ATLAS