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FOR OFFIC U E: __. . __. ...... --------- APPLICATION FOR SANITATION PERMIT Permit No. .... -- -- -- l LF �3::----- -- (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to�fhe San Joaquin-,L-ocSl"Realih District for a permit to construct and install the work herein described. This application is made in compliance with;County Ordinance No. 549. x JOB ADDRESS AND LOCATI' N---•--•-•• -��` •---•-... ..- ------•-- G Lr r Owner's Name --=-------•-- ----=-••--•----- - _--- ---------------------------•-- Phone-------------•-----f Address-----------------------------s ` 23- `T"`� r':r= .. Contractor's Name ....................v-� •-•---... . ------------- =........ Phone..... Insfallation will serve: Residence gf Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _+Y___ Number of bedrooms __rl. Number of baths _,l___ Lot size __--___, /-_... �_ `�, ................:.. Wafer Supply: Public system I& Community system ❑ Private ❑ Depth to Water Table . t Q _ Character of soil to a depth ofl3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Ej Clay ❑ Adobe❑ Hardpan ❑ h* Previous Application Made: (If:yes,date---.----------------) No Z New Construction: Yes ❑ Noj�] FHA/VA: Yes ❑ No 12L :I 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____-- {� 19 No. of compartments___-_.____.� - Size _.3k _ Liquid depth........ ------Capacity.......... t Disposal Field: Distance from nearest well ____!-T-----Distance from foundation....- ----Distance to nearest lot line......s_-. Number of lines----- ______-____Length of each line________ ___ .; ----�-- 9 ��------------Width of trench-----------------�,�:---••-- Type of filter m`aterial._.�_ .__Depth of filter material----------- __Y__��.__Total - length-.__-. ___Y o _________________ Seep ge Pit: Distance to�nearest wel�� ~____._,_Distance from foundation___Ze..e__..Distance to nearest lot = [ ' I.Number of.'pits--------- ____ti_---Lin ing material_- Size: Diameter____ - --".____Depth___.._2:-51'.- Cesspool: Distance from nearest well-_________:,_Distance from foundation--------------------Lining material------------------------------------ ❑ Size: Dia meter-------------------------------------'Depth---------------------------------------------------Liquid Capacity-----------------------•--_9als. it Privy: Distance from nearest well__________________----------------------_.____Distance from nearest building------------------------------------- Cl Distance to:nearest lot line------------------- ____________ Remodeling and/or repairing (describe):-------------------- -------------------------------------------------------------------------..----•-••-•-•-----•-----•--•-••-----•--------- II -- _.....:.»_-. ---•_--.__....--•-------------=------ -------- _--- -.---._......_..-----__-_---------------- -----------------------•------•---•------------------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, d rules and.regulations of e 5 n -a uin Local Health District. �. (Signed)•........... .. y----------------------- - -- ------------ --------------------------------------------------------(Owner and/or Contractor) By:----------_------------------------......... -------------------------------------- --- ---(Title)---------------------------------------------- ------ (Plo+ pian, showing size of lot, location of sysfsm.in relation fo'wells;buildings,efc., can be placed on reverse side). FORPnRTMENT USE ONLY} APPLICATION ACCEPTED BY. �� --------- DATE_ r G REVIEWED BY... ------------ -------- ---------------- '".""..`-` --------- DATE r BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------ Alterations ! d/or commendations: - - -- ---------------------------------------*--------------------------------------------------- 42 -------------- - -- ----------- -- ----- _---•- � SO/ - •---- ...S�' l q - j� .u.-..__,rel•--., - II FINAL INSPECTION BY: ------- --------------------------------•---------------- Date.-_.- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California Manteca,California Tracy,California Er 9 REVIrEo B-59 YM 8.61 ATLAS f