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kin, yr rll„C u3[: ------------------------- { ---- - .__. APPLICATION FOR SANITATION PERMIT Permit No. . ,?_.4..�-'__• - -.------. -y � --- ----- (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued Date Issued .S/Z. 63 Application is hereby made to the San Joaquin Local Health (District for a permit to construct and install the work herein d scribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A LOCATION LLQ- ,/- ' 4' rL, e----�-�- s .P- ;ens---- --,ec Owners Name ..... _ q- --- -- ...... -. Phone...... Address ---------•-- _ Contractor's Name-------------- �, Phone.... -- ------ -- Installation will serve: Residence House ❑ Commercial El Trailer Court Motel Other Number of living units: .. __. Number of bedrooms - m Nuber baths Lot size j C r Water Supply: Public system E] Community system [] Private pth To Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ZrClay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ Previous Application Made: {if yes,date _..__ _-_) No ❑ New Construction: Yes 2--'No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest ---,Distance from f�oundation-__-----YA___..Maferl i..._ No. of compartm�ts_. Size.° �t� r Liquid depth acitYDisposal , - ?-- Field: Distance from nearest well-_., .f-Distance from foundation...y 1 ' ' - -- .....Distance to nearest lot line----------------- Number of lines------- ------ --- --------- I ength of each line_------ �.'--- ------ .Width of trench.---- - -------------------- Type of filter maferial._�f�-ltDepth of filter material------/j.........-Total length__.-.-,� _Z?_ _-,---_- 1 -------- Seepage Pif: Distance to nearest well----------------------Distance from foundation-----------------..Distance to nearest lot line----------------- El Number of pits-------- -----------Lining material---- ---------- Size: Diameter---------- -----------.Depth.-- ----------------------- Cesspool: Distance from nearest well.---------------Distance from foundation.- . __-_---------.Lining material ..___..___--__---_ .- ❑ Size: Diameter------------ -- -r-------- ---- ----Depth----------- ---------------- - ------- ------ -----Liquid Capacity gals. Privy: Distance from nearest well------------------ Distance from nearest building ❑ Distance to nearest lot line_-_ --- Remodeling and/or repairing (describe:_. _. ------- ------------- ---------- -- ------------- ------- ------------------------- -- -------------------------------------------- --------------------------- --------- ------------------- ---------------- - ------ I hereby certify that I have prepar this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and gulations doffhnSanJoaquin Local Health pistrict. (Signed) --- ----------- ----(Owner and/or Contractor) gr• -- � . C -� (Title)-- ---------------- - - (Plot plan, showing size of lot, location of system in relation t` wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCT PTSD BY.___ f ---- - ---------------------- ----- - DATE.. J- IEWED BY---- -------------............. ..... _..._ - . ----------- - -- - --... --- DATE----- ------------------ --------- -- -------------------------------------- BUILDING PERMIT ISSUED-- - �-- ------ - -�----- - ----- ---... DATE------------------------ eratrons and/or recommendations:-- ,... ........ ---------- FINAL INSPECTION ..r-- - - --- Date.: ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street Stockton,Californiax,05 West Stir Street Lodi,California E5 9 REVISED 8-55 2M 5-62 ATLAS Manteca, California Tracy,California