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FOR OFFICE USE: _______________________________________ APPLICATION FOR SANITATION PERMIT Permit No. .f -------------------------------------------------------- (Complete in Duplicate) Date Issued Issued _._6 -F -------- This Permit Ex ires 1 Year From Date Issued ____ ._. � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the�� rein described; This application is made in compliance with County Ordinance No. 549. p Z3 -030- 0--.s- JOB ADDRESS AND LOCATI N.- _ 1�- --- ---.(1fJ..., '1__ _ --- --•. /./. .., f��T7.l /►�Ifit -.� ............... Owner's Name---•- b7../�- ------Sal".-"a_^S---------------------------------------------•--•-----------------•----------•---•--- Phone.............................. 4 _o�__...,A a _ Address '2 , /I --------- 1 ................................................................. Contractor's Name------------------- --•----•-••--- .............. Phone................................... Installation will serve: Residence PET—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __. Number of bedrooms,,. Number of baths -4. Lot size ---------------------*------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table 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 J2 —New Construction: Yes MINo ❑ FHA/VA: Yes P-1No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �y (No septic tank or cesspool permitted if public sseeJ r is available within 200 feet.) Septic Tank: Distance from nearest we ..A.. Distance fWom fo�r�dafi ➢ � .........Ma arias �'" Gr ` ................ No. of compartments______----_ r,"r�Y.� �4� cCLiquid depth___- K__/______________Capaeity./,,ZA. _12---__. .------._Size. --_-- � Disposal Field: Distance from nearest well_. ------Distance from foundation__Z2.........Distance to nearest lot line-,. Number (if lines-_____ __ ~ �� Num � �---- Length of each line__��Q-=�>t��.Wid#h of trench._ �-- - ...--�--------------•--- Type of filter material, ____r�G/G Depth of filter material__/,___--_-___-_Total length___- _____________________ Seepage Pit: Distance to nearest well_Z,?,f!_---Distance fr m foundation__l4__--•_-_-.Dis free to nearest lot iine__�___-___--� [K Number of pits_._._,--------------Lining material.,.- � --. p _P .Size: Diameter....... ... ......De Depth-0-9---.41-7- ------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------_--- ------.............Q ❑ Size: Diameter--------------------------------------Depth---------------------------------------•-----.-....Liquid Capacity............................gals. Ok) Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ Oa Cl Distance to nearest lot line------------------------------------------------------.......... Remodeling and/or repairing (describe):-- ---' ------- - ---••-•---•----•---------•---,__-................... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------- ------------------------------------------------------------•----------. ---------•-•---....-----------•----------------------------------------------------------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)......................... wl!, ,....... - --P-- --- ----------_--- ------------- -- ---------_-------•---�erb++1�/yer Contractorl BY: !/• Itle)---- ,/ . (Plot plan, showing size of lot, location of system in tion t wells, buildings, etc., can be placed on reverse side]. OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ g: ----------------------------------------------------- -- DATE-._,4.' 9 - " REVIEWEDBY------------------------_--------------------------------------- ------ DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-----------.----------------------------------.........•----• Alterationsand/or recommendations:------------------------------------------..................... ..................................... -------•----------•--•-•-•-•----••-•-----•-------- .............•------------•-------------------------_-----•---------------------I--------------------------------------•---............................................................ -----------•-----------•-------- ...................................... ----------------•---•---•-••------------------------------------------------------•-----.._.---•-----...-------•-----------------------------------•-------------------•--•----------- ---------------------------------- FINAL INSPECTION ----------------------- Date---------fp��f`` --------•----------------------------------------------- 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 6-59 ZM 5-61 ATLAB