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AOROFF ,t15 ,. -- APPLICATION FOR SANITATION PERMIT Permit No. . ...:............:.. /- (Complete in Duplicate) .7 -----7-1 L_ �3.. ��- Date Issued -----------------... -�------------ This Permit Ex fres t Year From Date Issued Application is hereby made to the San Joaquin Local�Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JO ADDRESS AND LOCATION---.-yee� 3------4&x---Al':�1s?� ----------- Owner's ---------- Owner's Name.... 7;. -�,.-------�------ ---------------------------------------------------------------------------------- Phone... Address.................. Contractor's Name.......... r.�-(.....- - ----•-- ..-- Phone.��K$.1 Installation will serve: Residence 9R�','-_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _. _- Number of bedrooms __ :- Number of baths ---/-- Lot size ..1 !--. _f�S.-.Q'............ Water Supply: Public system.❑ Community system ❑ Privatefn'-Depth To Water Table"V_ ft. r Character of soil to a depirh of,3,feef._'Sand Gravel_❑...Sand Lop m _-_ may.L _ E] Clay,Loam ❑ Clay ❑ Adobe[] ._Hardpan ❑ I Previous Application Made: (: if yes,date--------------------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or ces pool permitted if public sewer is available within 200 feet.) Septic Tank-- Distance from nearest well,tXV- ----Distance from foundation.-." __- r 0-& No. of compartments_- ` ---Size...Oa-�C�--�C.. Liquid de th-----�y-.------ Capacity q I? p tY S_P� S,R. ti f/ I Disposal Field: Distance from nearest we€l----------_-----Distance from''-foundation--------------_:..Distance to nearest lot line.__. �XG$Tf N6m Number of lines-�--------------------------------Length of-each line------------------------------Width of trench-------------------------• -• Type of filter material-------------------------Depth of filter material-----------------------Total length...............-_----..---_---_-_-_------ Seepage Pit: Distance to nearest well from foundation :: ----__-----_ _-:Distance to nearest lot line---_-_----:_..... p ^f� ❑ Number of its--- -----------------Linin material---------------------- :* SizeDia meter-_..----------; ="--Depth---------------------------------- Cesspool: Distance from nearest well-----------------Distance from founn----- _---:.----.Lining material..----_-.-.._----__-.__--------.----- � ❑ Size: Diameter---------------- ---------------------De th.---------------------A?-•--------- j------------Liquid Capacity gals. i fPrivy: Distance from nearest.well----------------------------------- 77-777-Distance) from nearest building------------------------------------------ neares .��... F - ClDistance to t',Cot line---------------- ------------------------------ :""""--... ---------•---••-•--------'----------•---•------- •---•-----------------...------------------ Remodeling and/or repairing (describe) -- -- ' ---- --- ---------------------------------- F , ......-_----------- 1 k + ordinance State laws ""^ _ - *.. ..-.. _ •--------------------------------- - hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County C s, , and rules and regulations of the San Joaquin Local Health District. i (Signed) -(`--�-- //' --------------------------------------- -- -- ---- B F ______"(Ow r�artd or ontr or�� Y= -------------- (Title) .:.. (Plot pian, showing size of lot, location of. stem in relation,to wells, buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------�R-.Q---------- ----------------- --------------------------------------------------------------------- PATE-------,�..�---�----`a'-�-�------------------- REVIEWED BY.. ------- ------ ------ DATE = BUILDING PERMIT ISSUED = -----------------------------------;.--- •---- -- DATE---------- . . s� E' �� C b rGc AMFerattons and/or recommencfc�ttons:.r _•.c__"_•-__----_--- ------- - -------"----- - -------------�- -•v--G-----t---et-e-�r---� z--�.----_-;-,- L-a•-z"'-�:G,/.�r�•,tr.Y-x�_� "--�---"-"-c' -P------e-�-- -Z..�I..-P�--~.`P. ".......------- ............. . - -• � ----7 —�-----"s-------�- -.�-^-�- ---=- " ----------- X_ -- -- _!u 9 -- FINAL INSPECTION BY:.. :i�� ----------------� ,x ; Date ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak Strut 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California' Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS ti�