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-� FOR OF E. _ (az -_---_. APPLICATION FOR SANITATION PERMIT A) Permit No. ... ......... ...... ----------------------- (Complete in Duplicate) 7 I This Permit Expires 1 Year From Date Issued Date Issued ..................t/. ------ -o1 Application is hereby made to the San Joaquin Local Health Distric for a permit to construct red install the work herein described. This application is made in compliance with County O,rddii�nance No 5.49. Ge JOBADDRESS AND LOCATION---16.........;E3 ................•------------•------------------------------------•----.........._.....------------------•---.... Owner's Name ' ----------------- Phone---------•-------------------••----- Address.............. t#. ....I f Contractor's Name_. .--•- - '' ----•--- Phone.............. Installation will serve: Residence 21"o'Apartment House ❑ Commercial ❑ Trail rj)'o rt ❑ Motel 0 .Other Number of living units: --- _/__- Number of bedrooms _-_ Number of baths�_.. Lo size_ ___.............................. Water Supply: Public system ❑ Community system Private ❑ Depth To Water Table:_, lift. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date------------.-------) No Q----New Construction: Yes ❑ -No ❑ FHA/VA: Yes ga- - No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) d _ Seprti�cyT�nk: Distance from nearest we,l�___"-'-'___Distance fro_ foundation-__/ -_-----.Materjal..,..��... �t'/.``,i��" No. of compartments_--.,,�__._-__--__-_-_Size l�1 ..__,?� ,..Liquid depth..... -.______________Capacity..Z. .. -...... DisposaField: Distance from neares well ---------Distance from foundation-_��.1........Distance to nearest lot line.-.. ...... l�J Number of lines------�._. ------ Length Length of each line__ `__,�____________Width of trench--�_....................._..... Type of filter material/��D4C+e':.Depth of filter material.._l�1,.-6-___-. g Total length C7 Seepage Distance to nearest well ------- tDistancefrom f undation...,f`_Ae --------.Distance to nearest Iodine...a��..... S' Number of pits------.E�___-_.__.Lining material 1Pe ___.Size: Diameter._2,,s?*......_.Depth./rel.._'.................. 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.......................................... Distanceto nearest lot line------ •-----•�-------------------•`--------------...................---------- ........................................................... Remodeling and/or repairing (describe)------------------/�-K-- --------<-S f' 'i`_. _s>b' . .............................................-•-•-• ------------------------------------------------------------------------ -----------------------------•-----------•---------------------•-----•-------••-----------••---------•---------.....•-------••----•--------•-•---------•-•----•-•-------•-•------••---••.-----••-•--------- ------••--------------------------------•--------------------------------------------------------------------------------------------------------------------•---------------------------------•----------------------------- 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 ruler and regulations of the San Joaquin Local Health District. t/ (Signed) f� -----�fowelk, ------------------------ ------------------------------- ,(Qwner'a�rd74er-Contractor) By:----------------------•-•---••-----••----------•---------.-•-•-•-------•-- E_ t'/f �' -'-- ........(riifle)....&Z 4_4t---�----------------------------- (Plot ---- - -------------------- (Plot plan, showing size of lot, location of system in rel n buildings, etc., can be placed on reverse side). FOlk DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. l 1�-- DATE - r....K ..R................ REVIEWEDBY.............................. -- ------------------------------------------------------------------------------------------- DATE............................................................ BUILDINGPERMIT ISSUED.---•-----•••••-------•---•---------••-------•--•--- --•----•-----•-----•----•--•------------••-- DATE.............................. ............................. Alterations and/or recommendations:....._ ._-_Z,_-�.y......4 `____ FINAL INSPECTION BY--- ---- -- --- --�_ Date �.._ ....... -�-- ...............---•----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Strout 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS