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FOROFFIgL.� I 2 ✓ -0 __Ip P ---- -------------- APPLICATION FOR SANITATION PERMIT ------------------- Permit No. --------------------------------------- ----------------- (Complete in Duplicate) ---------------------------------------- ---------------- - This Permit Expires 1 Year From Date Issued Date Issued ... _Z__ 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_447-///-- --------------- Owner's Name... _IRto _ __0---------- --------- ------------------------------------- ------ P h o n a Ile.-f.,�V.2 ay.'. Address................A9Z_'/.j........N " - y... ----•---•---•••---------------------------•---------------•---- -----------------•----•-•---........... Contractor's Name- !;X 'A 47a -------------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House F] Commercial [] Trailer Court E] Motel [j Other ❑ Number of living units: _1.. Number of bedrooms Number of baths ..At-'_ Lot size +.-._.X.__-__/_ - 0...................... Water Supply: Public system & Community system 0 Private F1 Depth to Water Table ........ ft. Character of soil to a depth of 3 fe;f: Sand E] Gravel [j Sandy Loam E] Clay Loam El Clay [I Adobe&I Hardpan C] Previous Application Made: (If yes,date--- ----------------) No jKl New Construction: Yes El No FHA/VA., Yes [] No KI YM TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from 'neare—st7' Distance fr?m foundation_:_-e4!-)-------Material-------2x(��..................... compartments.p----- ........... _5t( Li4t,,icl clep�h-------�/.. No. of c ............capacity..... Disposal Field: Distance from nearest well- 1 D istan ce from founcla.fion.A.Za!_____.Distance to nearest lot line.....A...... Number of lines----------%r----- -------------�Length of each line-40...... Width of trench..........ZZA _/-- ------------ Type of filter material...&747cld:�---------'Depth of filter material____1,?.............Total length-----------Zodg--,------------------ Seepage Pit: Distance t6_rTe_areit_7elI' /Oa'_'Distance from founclafion-Lz Distance to nearest lot line----47.".__ 5d Number of pits_-_.A------------Lining.,materialaa/K.......Size: D ia mete r.- Depth---------a.,V.............. 0 , i Cesspool: Distance il m nearest well------------KIDisfance from foundation....................Lining material Cl Size: Diameter----------_---------I-----------------Depth--,--------------------------------I--------------- ----------------------- i 1 -1 -Liquid Capacity----------------------------gals. Privy: Distance from nearest well________________________________ —--------Distancel from nearest *__%� 9 building----------------------------------------- 0 Distance fo nearest lot linei--------------------------------------------------------------------------- Remodeling and/or repairing i(describe): ---- -------------------------------------I......... -------------------------------------------------- ------------- ----------------------------------------i------------ z ---li�i, ----------- ------7---------------------------------- ----------------------------- ------------------ I-------------------------------------------------Z-_-------- -----------------------------I..............................I------------- I ------------------------I--------------------------------------------------*---------A__�-------......................................................... -- ----------------------------------- ---------------•-----......_....._..................................------ --------------------------............. --------------------------------------------------------------- I hereby certify that I h�ve prepared-this application.and,thaf Jhe-work will,be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of fhe!San Joaquin Local Health District. I (Signed)--------- -----------_------------------- -----------------------------------------(Owner and/or Contractor) By:................ ------ -- Itle) -------- ---------------11-----------(r --cZ .................------ (Plot plan, showing size of lot, locafi6W-of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY I P APPLICATION ACCEPTED BY x ------------------------------- 15ATE------- REVIEWED BY - --------------------------- -------------------------------------------------- ---------------------- DATE----------------------------- BUILDING PERMIT ISSUED ------------------ ----------- ----------------------------------- DATE...................................... ---- --- --------- Alterations and/or recommendations:---- ---- -- -------- 01" ..............................----------------------------------------------------------------- ---------------------------------------�4 ---------- ------- --------------- ------- -------------------------------------------- -------------------------------------------------------------------------------------- ------------------------------------------------------- ................................. --------------------------------- ----------- --- ------- 1 ------ -------------------------------------------------I--------------------------------------- .......................... .......................... FINAL_INSPEGTION-BY:.__-. SAN JOAQUIN LOCAL HEALTH'DISTRICT 130 South American Street 300 We.,Oak Street 114 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 YM 5-61 ATLAS