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FOROFFICE USE: ------------------------------------------------------ - - . -------__--------.--------------------------.--------- APPLICATION FOR SANITATION PERMIT Permi+ No - . � !9 ----------------------------------------------- --------- (Complete in Duplicate) Date Issued _ - /� 7� .... ---------------------------------------------__-----_.-.- This Permit Expires 1 Year From 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 pliance with County Ordinance No. 549. �� JOB ADDRESS XND LOCATION--'- ------ �'-- -- •-- -- n�f�1>/11:.S�.--.-°�--------- ------- = �, Owner's Name........ Phone--- .... .�.r�`___2 4 Address........... --•-•-•--------------•-• Contractors Name------1A.0DY_..__ _ IL V I-C E-------------- Phone..........................-------. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __,____ Number of bedrooms -* Number of baths _/--- Lot size ....___=Z ____./9 �.�, ______________ _ Water Supply: Public system ❑ Community system ❑ Private dDepth To Water Table 3 ft. \ 00' Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam;F � Clay Loam Clay E]lay ardpan C]Previous Application Made: (If yes,date---------------------) No E�} New Constion: Yes G—No ❑ FHA/VA: Yes ❑ No n TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within,200 feet.) lyy,, Materia --C�/�C; _...... Septic 'ank: Distance from nearest well-_5_0____Distance from foundation._.! ....._ , J ♦� No. of compartments----�2 --___.____5ize_ -X__ __ _ Liquid depth--------1-____-_----capacity....__. g2_. Disposal Field: Distance from nearest well--,5.V-----_Distance from foundation __i =._._.Distance to nearest lot line.... .........w Number of lines___________ _ ____.___Length of each line._._.- ` ' ► Width of trench____ ----- ----- - y Type of filter material------.�0-C_�__Depth of filter material___________________Total length--------- „..........8s- 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-----------------------------........ ❑ Size: Diameter----•---------------------------------Depth---------------------------------------------------Liquid Capacity............................gals. t Privy: Distance from nearest well-____________________________________ _______Distance from nearest building------------...............___.-_---.-.... ❑ Distance to nearest lot line------------------------------ ------------------------------------------------------------------------.__...----•---------------------------- i Remodeling and/or repairing (describe):-------- ---•----------------------------------••------- -------•------------•-------------•--------------------- �� --------•-- OC ! W = ------------ ------ ------ -------------- ----- ------X----- ------------- •• ------------------------------------------------------------------------------------------------- -- • ----------------..--...... .------------- ----------±-00.by5--------_. ---•-----8%jL_C a-------M---------A_DD----� -� `' .1t�C..._`�'R_ 4c t------� �IQ't� I here6 certify that I have prepared this application and that +he.work will be done in accordance with San Joaquin Cou ordinances, �te laws, and rules and regulations o2=Apy the -1100 al+h-@is#' M RR1SE— (Signed).-.- ., . J � � '```''- ------ --------.- y- f-----------------------------•----------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(T'ifle)-------------------------------- -------------------------------- )'Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION -ACCEPTED BY------7 ,a-:-----------------------------------•------------------------------- DATE------ f "— REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------•- DATE---------... ---..--.... BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--- -----------------------------------------------------•- Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------.....----------•-•------------------- --------------------------- -------------------------------•------ ...... ------ r,°. ';- ._...-----•--•-----._._..----- __.. 1_`1_A 6 ------------`---------- -----`•`-- -------------T`R�'"---...._._ =---------•--- �--- �� rr...--- i � �.D.� �?.----- -----------_ ---------- ------------------------------ -- FINAL INSP ION BY: Date-------- -------------------------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Atnericon Street 300 West Oak S?re*t 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California !'Manteca;California Tracy,California ES 9 REVISED 8.59 2M 5-42 ATLAS