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FOR OFFICE SE: _._ - APPLICATION FOR SANITATION PERMIT Permit No. . .. � ' --------------- '�` (Complete in Duplicate) /.Z -------- ------------ This Permit Expires 1 Ye::sr From Date Issued Date Issued .._._...._ .s� -- --- - -- ---- -- 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 -Y 2,:Z. 6....--/!9 _t} /Yl f i fl Owner's Name....../V =----------- S Q- --------------------------------------------------- ------------------------------------------- Phone..'-1v <4"ejs?' Address--------.............<<.S?��z4E.,) Contractor's Name.......... i_.. 51��Q:j � lz ,:ly ----;.. 'cnPhone. Installation will serve: Residence Q'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j-__- Number of bedrooms ---3- Number of baths _.2- Lot size .......7..........i'gQ? '.5............... Water Supply: Public system ❑ Community system ❑ Private [ Depth To Water Table ..t�l'.`- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam{'Clay ❑ Adobe ff Hardpan ❑ Previous Application Made: (If yes,date____________________) No 0' New Construction: Yes ❑ No 0''- FHA/VA: Yes ❑ No E5-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic TT rLk � Distance from nearest well.-------•-••---_Distance from foundation....................Material................................................. 17-1W No. of compartments------------------- ------Size---...-------------------------Liquid depth-------------------------.Capacity----------------------- Disposal Field: _ Distance from nearest well_6V__1_ ..._Length of each line..__.____._------Distance from foundation....../02......Distance to nearest lot line... Number of lines--------------/_......___. �_.... v g �d1--_.Width of trench._....�_.,./__2:`V.__`_'._____.... _ . _ Type of filter material._/VALp&--_--__Depth of filter material____ 1 `_'____Total length...._--------7-�._ -•------------- Seepage Pit: Distance to nearest well-/4'o from foundation..../.0.' _� .....Distance to nearest lot line-_. !.._.. 5dNumber of pits---------/-----------Lining material._.,�_tL4r/__'_Size: Diameter__... .. _..'.!_.Depth__....._ "-'............ Distance from nearest well from foundation material.....__......_...........___......... Cesspoo : ❑ Size: Diameter-------------------------------------Depth---------------------------------------------------_Liquid Capacity............................gals. Privy: Distance from nearest well----------------------------------------- ----Distance from nearest building.......................................... ❑ Distance to nearest lot line----------------------------------------------------------------------- Remodeling and/or repairing (describe):____-, 7,Q.p--------_--------70..._._.._..._... K__/.T%_!!✓C�_-__-____-•S_.Y.1T�Ao2....................... ------------------------------------------------- ..........---------------------••----------------------------------------------------------------------------------------------------------------------------------- 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)---------->�- a�` !' / 2c d h'------- ctQa!1� -------- -----/"�s ----`------(Owner and/or Contractor) By: -------------._Tale Y -------- -in - (Title) - - (Plot plan, showing size of lot, location of sys m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..----.. --------- . -ia- _:---------------------------------------------- DATE--- `- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------- •. Alterationsand/or recommendations:-------------------------------------------- -----------------------------•----•---------------•-•----•-------•-------•--------•---••••-•••------•---•--------- -------------------------------------------------•------------------ ----------------------_---------------------------------------------------.._......-•---•---------------------------------------•---•-------------- -------------------------------------------------------------------------- -------------------------------------••-•--•---------•---••--•--•-----•--•---•-•---•••-•-----••------•--••-------•-•-•---••---......--•----_...-- ------------•----------------------• --- ---------- --------------- ------- ------------ -----------------------f=-------•-------------------------------------------------------- ---------------------------.._-.- -----------------------------------•-------------------------------------- -- ----------- 6 FINAL INSPECTION y... --- ,� �'�..... .....4�.__0 --LY Date.. `z"'r ---••--••------------------- SAlK1JOAQUIN'LOCA HEALTH DISTRICT � 130 South American Street 30d`Wesf Oak SO./it 124 S t etr t Sycamore Sfig 205 West 9th Sheet Stockton,California Lodi,California / Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS