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FOR OFFICE USE: 1033v APPLICATION FOR SANITATION PERMIT Permit No. . . .. (Complete in Duplicate) 7�-e-- Date Issued This Permit Exl2ires 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-•- 2 ?jQ------ / /1�i Q�t T----------------------------------------------------•-------------------.--------- Owner's Name 21 -------------`1�Ql ---------------------------- --------------------------------------- Phone—gPh0ne-Gg _ Address........ E�-------------------------------•------------------------------------------------------------- -------.................----•----- q4 1 a Contractor's Name------'��' ��' '71rte�`�-H------0 �0�1/�-----------.��---- Installation will serve: Residence I' Apartment House ❑ Comrihercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __j-__ Number of bedrooms ,3--- Number of baths _" Lot size ------/_00_ ___ ,d G................ Water Supply: Public system ❑ Community system ❑ Private RR- bepth ro Water Table _6_4_. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No 0" New Construction: Yes ff"Na E] FHA/VA: Yes ❑ No! 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_,5-0_.___.,Distance from �.�- ' ---._.._.. No_ of compartments-------; rCapacity_/� _ ____________ 7 . rf J ' Disposal Field: Distance from nearest well___-tj Q._._Distance from foundation..._B---____-Distance to nearest lot line._..._.__. Number of lin"es--------------I------------------Length of each line-----------+�.Q------------Width of trench------------=it.K_v------------- Type of filter Depth of filter material------A6__11_--Total length_______________ -------- Seepage Pit: Distance to nearest well___/�fJ__..._....Distance om foundation____ Distance to nearest lot line------_______.. Number of pits-------7---------Lining material-_ f1C -.Size: Diameter----C3j_---------,Depth--..-------- ----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------.--------------.......... Size: Diameter--------------------------------------Depth--- -----------------•-•-------- --------Liquid Capacity-:-------------------------gals. , L1 Distance from nearest building 1 Privy: -J Distance from nearest well----------------------------------- - ----- 9 ❑ Distance to nearest lot line------------------------------------------------ -.-----------------------------------------•-------.---__-------------•-------- Remodeling and/or repairing (describe):---- ......•-- -- ----`---•-----------•----- .......__------------- - --------•-•------------•------- ---------•---•--•---•--------------------•-•---- --- - _ _ --•---••------•---------------------------- 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. - � � - - " --___-_a-��::_r.(Own and/or Contractor) (Signed)----------- -----�------------ ------------ - - - ---------- ----- - --- --- ---- - - - , sy:. — - - ---------------------------------------- (Title) l (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FO DEPARTME USE ONLY. APPLICATION ACCEPTED --- ------- -- - -- ------------- DATE -------- --� '--------------- --- --- --- ---- - - REVIEWEDBY-----'-.- ------•------- ----- ---------------------- ----------------•- DATE- --------------------- ---------..------------ BUILDINGPERMIT ISSUED-------------- •- - ------ -- - DATE-------------------------------------------------------------- Alterations and/or recornmen4efions:__._ ....-----•- •... --- ....................................................•--....---- •---------•-••--------••---------------------------------------------------------------------- ---------------------------------------------------- ... s -••-•--------•-`-------------------------------•----•----•---------------------------. -I------•••- i � ='i'" • f u . _ FINAL INSP ON BY: ----=-=�:-=-------- - ' -- -- -- - ------ - -- --- __ __________________________ - e_� ..-- - - AN JOAQUIN LO L HEAL DISTRICT a 130 South American Street 300 West Oak Sire 124 Sycamore Stmt 205 West 91h Street Stockton,California Lodi,Calif a Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS