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FOR OFFICE USE: ------ . . _) , •-t--- ----- - -------/----- APPLICATION FOR SANITATION PERMIT Permit No. (.°.�... --- - �------ (Complete in Duplicate) o --------------------- This Permit Expires 1 Year From Date Issued Date Issued _.`�._:.............. Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County rdinanallo. 49. )� pp�JOB ADDRESS AND LOfjCATION---011_.R-/------ - e....--- •••-----••-••---•----------•..............•----------•------••••---•-...--••-----------------••---.._... Owner's Name...UZ.+d a..--•--japell l.�-------------------•-•--------------------. -----------------------------•-------------- Phone.................................... Address..............;0 -- *X- -X�AA!V--------------•---•------•--------------•-----------------------•-•-----........----.....------•-----------•----.....-•-----•--•--•----------... Contractor's Name............AA*fls-(a'Q-T✓......................................................................................... Phone................................... Installation will serve: Residence Q<Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: /._• Number of bedrooms ..Z-. Number of baths . _- Lot size _.2 7.1.1 Zdp.............................. Water Supply: Public system [Community system [] Private ❑ Depth to'Water Table die ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe ]}'00THardpan❑ Previous Application Made* (If yes,date____________________) No New Construction_-,-Yes ❑ No ffo"FHA/VA: Yes ❑ No R-- TYPE OF INSTALLATION-AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept,ic, Tank: Distance from nearest well___�r--._._.Distance from foundation._.ji�._._....Mate iaL.�.l�r.'..�f'' .. . .............. In No. of compartments.._... .-Size. �.J-�--''�11___..._.-Liquid dept`h._.�e$L ----------Capacity--- ...... Disposal Field: Distance from nearest well----""---Distance from foundation_.._. ...,_.Distance to nearest logit line..d�........ [� Number of lines.- Length Length of each line........��.�.�s/-.._:.Width of trench....................... p Type of filter materia ly2;iW'Depth-of filter material Total length . ........................ ` Seepage Pit: Distance to nearest well_____'�"_-------Distance'fr fo nclation....AK._.-...Distance to nearest IIs t lint;_4^...... � Number of pits........,-__--_-__.Lining material-: ..Size: Diameter....�W._.........,Depth_._ iso..................... Cesspool: Distance from nearest well.................Distance from foundation-------------------- material..................................... ❑ Size: Diameter----------------------------- ........Depth--------------------...----------------------------Liquid Capacity----------------------gals. Privy: Distance from nearest well-----------------------------------------_-------Distance from nearest building------.................................... R ❑ Distance to nearest lot line -------------------------- ........I....................................................................................... emodeling and/or repairing (describe):------------------------ =0&..4 .;4 ............................................+.._ -------------------------------------------------------------------------------------•-------------------------------------------•------------------•-----------------------•------------•--•-------•-•.................... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws4anrules and regulations of the San Joaquin Local Health District. (Signed)-••------------- �� ------. ( /or Contractor) By:...---••.....................••-------••-••••----------•----`--------- ----------------•-lrile) ............................... (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--j r" ---------------------------------------•-------- DATE---'----,/0----`-,67-...------------ REVIEWEDBY---------------------------------------i- --------------------------------------------------------------•-------------------- DATE............................................................ BUILDING PERMIT ISSUED................... --------- DATE-- ...... Alterations and/or recommendations:._. --- - --••-----•---•------•••---•-•••-••-•--....------•--•••••••--•-------•--•-----------------•-------------•-------•----•-----•-•-••--•--••-•••-••----•---•••-••••--...--•••-•--•••••--•----•-••----•---------•-----•......._..... -----------------------------------------------------•-----------------------------------------------------------------------------------•--------•----...------------------...........----------------.....-•-•-•---------•- -------------•----------.......--•----•----------------•-------•----------------------•---•---------------------------------------------------------•-------------------------------------------..__...-•-••----•--•------•-•- -------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.. """ ------ Date..... ��. .__. -......................................... SAN JOAQUIN LOCAL HEALTH DISTRIC 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 YM 5-61 ATLAS