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FOR OFFIC 4 �) - ___.._..__.E_____ _ __ ___________ A-z3_ APPLICATION FOR SANITATION PERMIT Permit No. .t ----- ------ ------------ (Complete in Duplicate) 11 _ ....................-------------- ----- --=�-.'-. This Permit Expires 1 Year From Date Issued Date Issued ._.................... Application is hereb Vmade to the San Joaquin Local Health District for a-permit to construct and install the work herein described. This application isr a in compliance with County Ordinance,No. 549. ` - .. — - JOB ADDRESS A L ATI Q --•.4q1l� r -:/ � y -- ..: .._-""' "... ........... = Owner's Name ----------------- Phone-------•-----•-----•------------• . Address-------------- - -�S6 p Contrattars Name.. .............------•-------------------------- ----------------------------- Phone............................... will serve: Residence ❑ Apartment House commercial_❑� Trailers Court ❑ Mail ❑ Other ❑ Number of living units: A__ Number of bedrooms --- Number of baths --at- Lot size 1��a�-___-__--__-_--_____- Water Supply: Public system �,/Commurii system Private_ De th to Water Table _619-a- +.' Y IL�f tY Y ❑ ❑ p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [:] Clay Loam [3QQ Clay ❑ Adobe -'Hardpan ❑ , Previous Application Made: (If yes,date--------------------) No W"New Construction: Yes EEr-`No ❑ FHA/VA: Yes ❑ No E3— I TYPE OF INSTALLATION AND SPECIFICATIONS: -1 (No septic tank or cesspool permitted if public sewer is availab a within 200 feet.) Septic Tank: Distance from nearest wel ---'" "______Distan , from foundation____le___4---material___ 6 No. of compartments____ '_____....Size .0. o�l.�_ Liquid de�th___W - _l�__---____Capacity_ t i ..._.. Disposal Field: Distance from nearest well ------ ell ��-__-._Distance from foundation---la......_.Distance to•,nearest lot line.�J..... ©� Number of lines*___,___ '.�___ ______ Length of each line____ "_ Width of trench__2----------------------------- - Type of filter material, Depth of filter material...l_---_-------Total length___---.................... Seepage Pit: Distance to nearest well----_'-__^-`--------Distance om f undation..../60./_..D's rete to nearest lot line---to—e_____ 9 P Number of pits------ .__.-------Lining material _.Size: Diameter__— ---------- r17,�.................. N Cesspool: Distance from nearest well-----------------Distance from foundation--------------.___..Lining material..'_+,___--___-_______-..----------. � ❑ Size: Diameter--------------------- -------------Depth----------------------------------------------------Liquid Capacity. •-•--•--••---•-•-----...gals. ip\ Privy: Distance from nearest well-------------------------------------------------Distance from_nearest building---:•_::--•------•---------------------- ❑ Distance to nearest lot line -•-•---------------------------------------- Remodeling and/or repairing (describe)------------------L - .....................:--------------------------- ------------------------------------------•----.....----------•-••----------------------------------------------- -------------------- --•-------------- ------------------------------------------------ ----------------------------------------------------------•-------------...-----------------•----------------------------------------------------------------------•-----------. ------•--••---• -------------------••-•-------------•-------------------------------------------------- --•----------------------------------------------------------------------'-._...----•-----•----------------- 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)------------- ------- --------- -- --- ---------�or Contractor) BY� - ------------- --- . ....:`_:-_._(Title)._ ---------- ------------------- (Plot plan, showing sire of lot, location of system in rel o wells, buildings, etc„ can be placed on reverse side). R DEMRTMEn USE ONLY CY APPLICATION ACCEPTED BY-- 'c__-- -- -_ • .--.....___ DATE---------- ._ _ ---------------------- ; REVIEWED BY ------------•---------------•--------- DATE = BUILDING PERMIT ISSUED-- ---------------------------------------------------------- ._... _�_ �. TE-- ---------------------- Alterations and/or recommendations:_.f -__L '�---- - /.. (, -�Q ----------------• ; ----------------------------------------- ----- ----------. .-----`..---•-----------•------------------------------------..--. .......---•----- .-. -----------------------------------------------------------•-•--------------•----------------------------------------- , ------------------------------------- --------------------------------------------------- --------••----------------------------------------------------------------------------------------------------. --------------- I FINAL INSPECTION BYcf, --- -- Date--------------------`--"--_ . i .SAN J_OAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street : Z 124 Sycamore street 205 West 9th Street Stockton,CalEFornia todl,-California Manteca,Callfornia Tracy,California ES 9 REVISED a-59 PM 5-61 ATLAS �i \