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FOR OFFI SE: 14, ____ Permit No. - ~ � APPLICATION FOR SANITATION PERMIT �� > Com lete in Duplicate) I' pate Issued ..__.__-.---•-------• This;Permit Ex fires 1 Year From Date Issued --------------------------- Application is hereby made to-theSanJoaquin Local Health DlNo�549.a permit��on ej,and install the work herein descrl e . �JJ This application is made incompliance with C y d 9 C�---------------- sy --------------------- JOB ADDRESS A D,LO TI ... --------- ---- - ------------- Phone-----------------------------•-----• Owner's Name.- ---•--• -------Z5 ----------------- Address - ---- - y� .•� C Phone. ._._I: l_.. Contractor's Name_______ _____ __ Other ❑ Installation will serve: Residence [Apartment House (3 Commercial ❑ Trailer Court ❑ Motel ❑ Number of living units. --�._-_ Number of bedrooms .-2-- Number of baths J--- Lot size ------ ~-------• Depth to Water Table _' Q ft- Water Supply: Public system Community system ❑ Pr15aned❑o Dep Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ❑ Y E�• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Y No� Previous Application Made: (if yes,date---_------_---------l No �New Construction: Yes o ❑ FHA/VA: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material---- ---------------------- - ----�^---___Size____ foundation./49--- �_�6a aci ;� ps5'x- Liquid depth p ty--- —V Sept' T nk: . Distance from nearest weft_______ _ Is}ante from a� No. of compartments_-_____. e al Field: Distance from nearest well- —""-------Distance from fou ation__��__.___.__ to nearest lot -------------- -Distance1Fne.-: -Dispos Width of enchy.---.---•- �/ Number of lines-•-_�---- Length of each lin ---IQ-----• + `` Total lent �'L�------. : G-- Depth of filter material_/Y...-----.--• g, Type of filter material._. - a__ -- ---- P r 1D _---_-__.Distance to nearest lot line l`5 ------•. o� See�eNiDistance to nearest well____ ------------Distanceom foundation- 34 r4__----- Depth____ tF-•�......•• Number of pits-----I--------------Lining material' epi----Size: Diameter___ i Distance from nearest well_________________Distance from foundation_-------------------Lining ma#erial____.__..__.__..__-__.__...___._8`S I Cesspool: -Liquid Capacity-------------------------- Size: -----------•------- --- 9 --De Depth •---------------- ----------------------------- Distance - ------------------ q . - ❑ Size: Diameter------------•--------------------- p - - 1 Distance from nearest well------------------------=• Distance from nearest building •----------------------------------------- Distance --•--------•-------- ------- ❑ Distance to nearest lot line_________________________ ------------ I .. - - -� / ----- ; Remodelintnd/or repairing (describe)--------------•------------ ;�� A --��-• _ .--- - -------- �, �" - {�� 1 .�-rrs cc .,,-�i- A. hereby certify that [)lave prepar this application and that the work wdl be one in a oldance wi#h San Joaquin,Coun#y ordinances, State laws, and rules and regulations of the S Joaqui Local Health District. t [Owner and/or Contractorl (Signed)_ . -----------(Title)------------------ -------------------- -- -- - ----------- sy:. (Plot plan, showing size of lot, location o n elation t wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY r �.r..� ---------------------------------------- DATE------4-7-7 -- - •------- APPLICATION ACCEPTED BY-- - -� . DATE------------------- ----- -------------- 7REVIEWED BY__. - - ------ -------------------- DATE---------•------•------ -- BUILDING PERMIT ISSUED--------- ------- ---------------------------------------------------- / Ir�3 Alterations and/or recommendations:___ /1 '� ------•-•----------------- ------ -•--- oy_ --------- -- _ - Date FINAL INSPECTION BY:.......... ..4- --• ---•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 ,CaliforniaOak Strtael 124 Sycamore Street 205 West 9th Street 4.rx Manteca,California Tracy,California Stockton,California Lodi,C ES 9 REVISED 8.59 ZM 5-62 ATLAS -!