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FOR OFFICE USE: ---------------fes, ____.............. APPLICATION FOR SANITATION PERMIT Permit No. '.� `.�./. ------------- 1 (� ` (Complete in Duplicate) 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 w_oLL her 'n'describ This application is made in compliance with County Ordinance No. 549. t p0(v JOB ADDRESS AND LOCATION._.___. POR QR_.___.__ �_._ ...5 ---- A- -R�Owner's Name----------- ------•--- Phone.................................... Address------Rw•- ( -DefC70--------- N------- Contractor's Name.JMANT � --------- ---- ---- - -------------------- Phone----------------------------------- Installation will serve: Residence Prfpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 11------ Number of bedrooms 5. Number of baths 2,-- Lot size ._._�_o .......................... Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam IT Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_.-----------------) No J 'New Construction: Yes Z?-tTo- ❑ FHA/VA: Yes ❑ Noe TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well--_, .-__DistayXro�Tyfgun ation__--/ _....._.Mat nal__. (�� ........ No. of compartments-_.__._—:-_--.-:::Size__ _..•----__,,__CC__''--.-XX------._.. iquid depth__ __-�]''-:_.______._Capacity._f��.Q. Disposal Field: Distance from nearest well ----Distance from foui do .....to.......Distance to nearest lot line....571.�r �- Number of lines-------- ------------------Length of each line----- a Width of trench....rlrn Type of filter material._I?40<-K----Depth of filter material--_ ` o1al 'lerrh.........._ ........... Seepage Pit: Distance to nearest well ______________Distance from-oundation....................Distanite to nearest lot Tine................. ❑ Number of pits----------------------Lining material _4- {{. ".Size:'wDiamei�r :, -- -------Depth------------_--- .------------ Cesspool: Distance from nearest well-- --------------Distan frojn foundation... .___._ 4ining(material..................................... u.._ ffii ❑ Size: Diameter------- ------------------------------Depth _ ------------•-------- -------- I,quidf C acitY gals. Privy: Distance from nearest well--------------------------- --_.--. -.-_ --- - ----- - .--.-Distance from nearst building__'.................. ............ ... Distance to nearest lot line.. . ._ _ .__---------------------- ._. � ,,__ x _ ----------------- Remodeling and/or repairing (describe):-- -- ---- ----------- ---------------------------------------------- . ------------------------------------------------- ---------------------------------------------------------------t•---------------------- --------- ------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------•--- •-•-----------' ------------------------------------- --------------------------------------------------------- -------------------------------------------------------------------------------------------------:--- ,-------------------------------------- - 1 hereby certify that I have prepared this application and that the work will be done iii accordance with San Joaquin County ordinances, St I S, and rulp and regulations of the San Joaquin Local Health District.t - -k (Signed) -- ----------------------- -- -:7 7,7---- - - ---- ------------- -- ------- - ---- -----(Owner,and/or Contractor) `S By:-- ----- - ----- -------------- --- - ------ -- ----- ---------------------------------------(Title)---r----- ------------ ------ (Plot plan,'showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-.----_.---1---<-R C-A -__- DATE......... -6._"_ �--- REVIEWEDBY-------------------------------------------------- ------ DATE............................................................ BUILDINGPERMIT ISSUED----------------------------------- ----------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---------------- ------------ ---------------- --------------------------- ----------- ---------------------------............................................. 0A ----- ------s�ow.4------------ - r . ---------- T -------------------------- -------------------------- ----------------------------------------- ----- --------------------------------- �C � � Date-------- / FINAL INSPECTION_..BY,:�. .. ..._.--- -- --- - --- ------ SAN - ------ 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 E5 9'-4EV4SED 8-59 2M 5-62 ATLAS