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FOR OFFICE USE- ------------------------------- ----------- ----------- SE:------------------------------------------------------- ---------- ------------------------- --------•-- APPLICATION FOR SANITATION PERMIT Permit No. t '.. - (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....e "7le..----- �c`_r_h4e9 e------� P�3 ----------Rd................................................... Owner's Name--------A c-t_.....-•-- f n y ---------------- Phone.XX " Address.............;Krel�f....... ! ------- Contractor's Name-----/_7x--- / -- .a1Y ....... -------•--•----------•----•------------------------•-••---- Phona,: ............ Installation will serve: Residence [zr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ® �4 ^j L, �/ C YC S Number of living units: __�`.._ Number of bedrooms _J--- Number of baths .1--- Lot size ----.-3.;." . ....... ................................. Water Supply: Public system ❑ Community system ❑ Private 0 Depth To Water Table 1-10---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date------------------_) No g] New Construction: Yes ❑ No KI FHA/VA: Yes ❑ No 0 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.- Q of__Distance from foundation---K!.-`--.----.Material---- .t' _�__?'_I ............ No. of compartments--------A-- -------------Size- -,...Liquid dep .----.th-_._-V- CapaciTY-A% _- Disposal Field: Distance from nearest welll'1�4P.......Distance from foundation..---tP. .......Distance to nearest lot line.Z4T_-.`..- Number of lines------- Length of each line.... of trench---�-`a�.`.�.................... Z-- -----_- - ea Type of filter mate rial.-� ../� --- -.Depth of filter material__-�----------------Total length-----------._.__-.--................... ... Seepage Pit: Distance to nearest well----------------------Distance from foundation-----_-.-----------.Distance to nearest lot line_--_-------._-.-. [] Number of pits----------------------Lining material--------..-- _-------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------------- El Size: Diameter-------------------------------------Depth----•---------------------------•-----------------•-Liquid Capacity--------------•-------------gals. Privy: Distance from nearest well----------------------------------------- ------Distance from nearest building------------------------------------------ 0 Distance to nearest lot line-----------------------•---•--------------•--- ----------••-•-•-•------•---------....---------------•----•-••-----------•-------------------- Remodeling and/or repairing (describe):_____ ------- -------------- ------•------------------------------ -----------------------------.... -----------------------------•- -----.----------------------------------------.------------------------------------------- ----------- 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. G=. ?� S¢- _.(Owner and/or Contractor) (Signed)--------------- --------- ------ Ao' -�-•--•• ��------- - --••----------------------------------..-..---------------...----------(Title-----��'------ -��!:-� ...... - --------- (Plot pian, showing size o o , o o system in relation to wells, buildings, eta., can be placed on reverse side). FT DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ----- ---------------------------------------------------------------- DATE- ----•- - �-=��-(�--- -• ---------------------- REVIEWEDBY---------------•-- - ------- DATE------------------------------------------------------------ BUILDINGPERMIT 155UE -----------------------------•--- ...- DATE------ ----------------------------------------------- ------ Alterationsand/or recommendations------ ----------------------------------- -------------------------------------.------------------------------------___---------------------------------- ------------------------------------------------------------•---------------- - ----------------------------•------•--•------------------....------•------.......-..-.-----------••----------.-------------•----------- ........................•----.-------------------•--------- ------------------------------------- -----------------•---•--•-••-•----------------------••-----------•------------•-------------------- ----------------------•----.....-•-• ---------•--------•-•---------------------------- ••--------------•- -•------------------------•-•------------------------------------------------------------------------ FINAL WSPECTIONB -- - --- VW6_4 -- - - - -�--------- Date------------- -----------------•--•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B•59 2M 5.62 ATLAS