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FO�t FI USE: ._. � a1�/tf �y f�iK1, �+ --------- t- -._- __.. :- --------�_-____ ..t�__ APPLICATION FOR SANITATION PERMIT Permit No. ..�j..:�.. -------------- �� (Complete in Duplicate) !f j /( 3 ---..------------------------ ---------------------------- This Permit Expires 1 Year From Date Issued 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 CountyOrdinanceNo. 549. JOB ADDRESS AND LOCATION-------- ----��,/•-- 'L _ 17/0.. �rru _.4j .. /ja.............................................. Owner's Name.-----------�4t -j ----..O/ ,a.lf/_..1-_,C/Y,C- ------------ Phone.................................... Address .�2a./.._......._.''.....�G.��............... Contractor's Name..... r -- ---------------------------------------------------•---._...------------ Phone.........................•. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...I... Number of bedrooms .3__. Number of baths . .... Lot size ---1.!7447 �? ......................... Water Supply: Public system ❑ Community system ❑ Private E&-'6epth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeC]Hardpan Previous Application Made: (If yes,date--..-..-____-_--__) No E] New Construction: Yes �o 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 Teak: Distance from nearest well-1 -------Distance from foundation...l0...........Material....Cif--dYIxn... .......... No. of compartments---_ -------------Size..ila.X�4P....:---Liquid depth---- ---------Capacity.-t'6'v.-------.- Disposal Fioe. Distance from nearest well--:--/...Distance from foundation./.k..'.......Distance to nearest lot lineZ-.'/...... [ Number of lines___......_ ------------------Length of each line....P!S.7--1' %''.Width of trench._,-.0_,t.. 7...........:.... Type of filter material... ____. _._.Depth of filter material_./._�_ ----------Total length___..,6T..-__.__.._............. Seepage - Distance to nearest well_-_ ' --------Distance from foundation....,-4---------Distance to nearest lot line................. EV Number of pits------- :__Lining material__x G /_:Size: Diameter-�,,-S............Depth---- ................ Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material..................................... ❑ 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) 3- ------ -a. . .... -•. ------------------------------------------------------------••----------------------------------------------------------------------------------------------•----------------------------•---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law"d rules 74regulations of the San Joaquin Local Health District. ,,Z(Signed)-------------- 64-�v--- � -- ----- ---- ------------------------------------------------.---------- --•---(Owner and/or Contractor) By: a � --------------------------------(T'itle) (Plot plan, showing size of lot, Iota ' of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----C -------------------------------------------------------------------- DATE 1 7 ` -----.....-----------........-- REVIEWEDBY----------------------------------------------------------------------------- ------------------------------------------------ DATE.............................................-•--••----•--- - BUILDING PERMIT ISSUED ------------------------------------------------------------ ----------------------------- DATE............................................. ............ After tions "d/or recommendations:-- Z -----------1-�i� 4 .u�!� .� � ... ------------ f= -----7--5•......•---------------------...................... ........................--------------•-••-----------------------------•---•------ ------------------•--------------------------------------------------------------------------------------------------------------------..------------------------------------•--------...----------------------------------•- ........•----•-•..................•----•------•-------•----•--------------•---------------------------------- ---•----•--•-•-----•-----------•--------------_.......---------------•-•-•--......---...---------•----_.._. ........................................- ------------------------------------- -------------------•-------------------------------------- -------------------------------•--------------------------------•----••-------•--- FINAL INSPECTION BY:-----C-------- ------------------------- Date--- 7 -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS