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FOR O ICE SE: Y Z .-- . z- ------------f APPLICATION FOR SANITATION PERMIT Permit No. ,� ...: --- (Complete in Duplicate) -47 ---------- ------ 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 th work herein described. G This application is tmiddle in compliance with Co my Ordinance No. 549. oil-) --- -��j'sY JOB ADDRESS AOCATION-. t-_�-- -ye---� .--t`v�_C. ----- „ -- �Owners Name--=--- - ----- --------- ---- ----- ----- ------•-••--------------------- --------------------- --------•----------..- Phone-------------------- ....------••-- Address------------------------ --•-•- •---- 1 ,/ Contractor's m �� \ ......A Phone, J•- - -.- p_ Installation will serve: Residence A artment - e Com erci I Trailer Court ❑- Motel ❑ Other ❑ Number of living units: I-._-_ Number, of bedrooms-, _ umbeZepth ths _:. Lot size ...-,�1-- _.l_______________________________ Water Supply: Public system ❑ Community system ❑ Private To Water Table z ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ 'dobe -Har • dpan❑- Previous Application Made: (if yes,date-----------.--------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ h TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public/;ewer is available within 200 feet.), w Septic Tan Distance from nearest well-5Z Distance from foundation/P4. _-_r--.......Ma rias_-- ..................... No. of compartments-- -------------------Size_ ---.Liquid depth--..-6.0-"-f-----Capacity ! r, ® e/ Dkposak Field: Distance from-nearell.f¢-�?.-._- -.-Distance tom foru�ndation__,p_ 4'�:_-Distance to nearest lot line:,f O._.... Number of lines------ -.-__- ._ ----Length of eaci Irne9.._.Gct_ri'._-_z - 1Vllidth of trench-----------_ C_________________ Type of filter material Sa--_ . -Depth of filter material.._I -rj-_--.Tofial iength �_.`.-_-rl^��-_--- Seepage Pit: Distance to neares well-/_-Q10-f. ---.Distance from foundation_,..-?-_O-""-.Distance to nearest lot line.. Number of it Linin material-___ e --.Size: Diameter_.--,Y,7_ P 9 ��--.-Depfh----��`------------ Cesspool: Distance from nearest well-----------------Distance from undation---.-.----.--------.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 repairin (describe):--------------- -------------------------------- -...------------------------------------------------------ . ' 'I ----•--•----- f ----- 'F - -.-- ....... ...... -------------------------------------------------------------------------------------------------------------------------------------------------------------- --------•---------------------------------------- hereby certify that I have prepared this application and that the w rk will be done in cordance with San,Joaquin County ordinances, S+at Aarules end regulations +he ,.�a-deagyrin L al Health District.(Signed)----•-- -- -------- _, ._.. . - -- L------ ---------------••---------- Contractor) ---- , (Plot plan, showing size of lot, location of system in relation t ells, building2c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- "A___ ----`----_- -----------------------•-------•-------------------- DATE.... � /-1� !—? s REVIEWEDBY--------------------------------------------- ----------------------------------------------• DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------- ----•--------i----•------ --------------------•--•------- DATE------------------------- ----------------------------- Alt ations and/ar commendations:----- -_ - � .�:� = -_-___ �- T``'_ %r -_--• -- _ - -------- - - D -- / tvv ?- -- -- ... .17A��I � - -- --- - ------------------------------ . �r �� ,� FINAL INSPECTION BY:.------- � - --- --- ----�''-`-�-�---�_-=-- . Date---------- -------------- - - - AN JOAQUIN LOCAL HEALTH DISTRICT x 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodl,California Manteca,California Tracy,California t# ES 9 REVISED B-59 2M 5-62 ATLAS