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FOR OFFI E SE: ' .°` ✓____. __.."__�� L:.3_------------- APPLICATION FOR SANITATION PERMIT Permit No. .� � ..______----� --------- - -- - 7-1.0----- + (Complete in Duplicate) f - ----�__-f/.- _�J ._._ Date Issued --......,•-- u� -�----------�--��- - This Permit Expires 1`�Y�ar 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 cof5 pliance with County Ordinance No. 549. aA- 6'-t_f0-� AJ- T/�cN ria271y ow 6'Es�i� i�'. JOB ADDRESS AND LOCATION iy----------------------------- Owner's Name_. .. � _6,0 A7—-------- ------ '___a_-- -1 as©' Phone �.9.- .7........... �S� z.C..7 --•----------------------------..-------------------- -•------, .. ---------------••-----•--. -------------------•-----------•-------------•••-•••. Address---------------------- Contractor's Name «/ ---- /.....- _A– s--------------------------------- Phone.......................-- Installation will serve: Residence [!f Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ../____ Number of bedrooms Number of baths Lot size ._5�C?___ _ e E__-_-_---____________________ Water Supply: Public system ❑ Community system ❑ I Private []Depth To Water Table _ a. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel I] Sandy Loam 2' Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made. .[If yes,dote--------------__._) No Er New Construction: Yes ❑ No Ef FHA/VA: Yes ❑ No 01, r. TYPE OF INSTALLATION AND SPECIFICATIONS: ! °� ! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material _____-...______._....__..........____._.______... ❑ No. of compartments------------ --------- Size-----------------------------.Liquid de th_- - ---------._Capacity.------••---------••--- Disposal Field: Distance from nearest well...SQ'_-_D~sance from foundation---.lO..........Distance to nearest lot line_/_ _'_... Number of lines-------------- Length of each line------3-► _'-_..---------Width of trench.----- ---------------- a ��.-, {�. Type'of filter material... ____-"'�-Depth of flier matenaE------«'_____._.__Total length__________________________________________ f-1 f Seepage Pit: Distance to nearest well__! -'_____-D stance from foundation---1-_e-`.......Distance to nearest lot line__ .`_.. `,b /4 p - g e - - .f�__....__Depth--------- �. Number of Its.__- _ _J- ___ ___ Linin matenal__ zf�0 ___ Size: Diameter"-- g 2cS= �F Cesspool: Distance from nearest well-----------------Distance from foundation..__-_____.______- Linin material-___._.._________ i' aEl Size: Diameter Depth ------- Li uid Ca Capacity... •--------••------ -----gals. ¢k Privy: Distance from nearest well----------------------------------- _____________Distance from nearest building--------_------___---_____.._-__.___. _.. 3j ❑ Distance to nearest lot line Remodeling and/or repairing (describe):----------'Odd._--__--e----- ---------_ -----.._..--•---•-----------•-•-----••--------•-•--••-•----------------------------------------------=-------•----------•-----------•----------••-------------------•-----------••--••--••--------•------------------------- . ------- ------•--------------•------.--•------•--------••---•-------••--------------------•----•------•---•---...---•---------------...-----•-----•-------------•---•-----•------••----••-----•----•------------------------- 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 rules and regulations of the San Joaquin Local Health District. (Signed} l ------'---- t ----_..� ( ner and/or Contractor) ' ---- " By: c {Title)- (Plot plan, showing size'of l�Iocaflonm inrelation-4o wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----A/< �.._�'-�,,--------------•----------•-------------------- DATE--- /��' REVIEWEDBY------------------------------- ---------------- --------------------------------------------------•-•------------------ DATE.-------------- -� --•-- - ------ BUILDING PERMIT ISSUED__ •--------------------------------- DATE. ----------------------- Alterations an recoyamendations. - –C - �:_ = -- 41 ----- FINAL INSPECTION BY:" - -- ----' Date--.---:psi'�'�.`.-__-- – ✓ p�p 5 N JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 30 west Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS +