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FOR OFFICE U E: __________ ----- -------------------________________.__.____ APPLICATION FOR SANITATION PERMIT Permit No. ....J._ ----------------- --------- ----------------------------- (Complete in Duplicate) >� Date Issued ...... / --•...................................................... This Permit Expires 1 Year From Date Issued J:__6 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 LOC TION__... C-r7,r- Owner's Name rKz 1_ ............ --P �L. ..... Phone�,1�.. Address-_. Zryn....... ...�-r er....... 1 '" ' --- ........................ :.................... ..................... � 4, Contractor's Name '_... a :Fc ... ......�:......................... Phone................................... Installation will serve: esidence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .._.,Number of bedrooms /... Number of baths �._ Lot size ....._.. 0 -y:._ Water Supply: Public system ❑ Community system ❑ Private p—Ve—pth to Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2--tlay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No 2- New Construction: Yes [] No g3---FHA/VA. Yes ❑ No-Ea — 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...x"42..Distance from foundation... .%:!.1.......Material...__Xs.... XNo. of compartments.....___.. ------ X k ,f`�,._.Liquid depth.......Y...............Capacity.......X..5;P.it. Disposal Field: Distance from nearest well__._'X-0...Distance from foundation.....3._ie�.....Distance to nearest lot line.......sF"`.�? Number of lines............../.. .._____.____-._Length of each line.............��.......Width of trench........... Type of filter material... -��_____Depth of filter material.......4t*,X__ .__Total length................... ........... 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: Dlame#er-------- ..........................Depth- ---•............................................Liquid Capacity...........................gals. Privy: Distance from nearest well................................................Distance from nearest building.......................................... ZI Distance to nearest lot line -----------------------------------------------• -.................... ._... Remodeling and/or repairing (describe}:___._., 'Y J _ -Eer=byc�Kfify .�. .- 4f*,---- 1 that I have prepared this ap ication and that'the work will be done in accordance with Sa�oaqui County ordinances, State laws, and rules and regulations of San Joaquin Local Health District. 1-6- n •.,: (Signed)--------------------- A) - ------ ��F��?L . - ------- -- ---...-------•--•------...._.-------- ---•---------------•-•-----(Owner and/or Contractor) By--------------------------------------- ---------"...........�`�_.......... ..... (Title) ............................................ (Plot plan, showing size of lot, location of system`in�relation to wells, buildings, etc., can be placed on reverse side]. ,. —,F ..DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ; _....-_ DATE-------yam REVIEWED BY ----- ------------------- - BATE -= - BUILDING PERMIT ISSUED............. �-"�'-i'`" = �. ] ........... DATE... Alterations nd/or•recommendations:....__...__!_.._._____ - % .di_ - ------------------ ---------------•-------- ------•--•- -- -----•----• -••--------------------•--...- 1-1 tF „rt{ _ - --------•---------- ---• ......... ...... ...._......... ....... ----------•-----------'-•---_ ________ ______ - __________ ______-_..____........ .......____-......._____._..........___• -.... -----------------------------------------•- __._.. ._._.._. 1 FINAL INSPECTION BY:....... ..... . --------- -- Date. ----- _ ... � ly SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Strut 114 Sycamore Street 205 West 9th Strut Stockton,California Lodi,California Manteca,California Trolly,California [S 9 REVISED 8-39 BM 3-61 ATLAS -