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FOR OFFICE USE: , y_________________ 14-1 z) APPLICATION FOR SANITATION PERMIT Permit No. ...................... -------. .... -- ----------------------------- (Complete in Duplicate) ----------------------------- This Permit Expires I 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 Ordinange No. 549.' JOB ADDRESS AND LOCATION._... Z�tk ................................................................................................................................ Owner's Name.............4La k............ an 1: .... ............................................. Phone................... ------------*--------------- Address....................I.V j......r......... Z Z �PT—v.. ........................................... .................................................................... Contractor's Name.—.-b..�ck..-----•---WAC-----------------------------------------------------------I...................... Phone................................... Installation will serve: ResidenceN Apartment House [] Commercial 0 Trailer Court [I Motel 0 Other El Number of living units: Y... Number of bedrooms -,.1-_. Number of baths ...L Lot size ..... A...... .................. Wafer Supply: Public,system N Community system [] Private [-] Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand 0 Gravel C] Sandy Loam E] Clay Loam [-] Clax Adobefg Hardpan 0 Previous Application Made: (If yes,date----------- --------) No'® New Construction: Yes, ] No [] FHA/VA. Yes F] NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--/! —Distandb frorrit foundation..............L....Mat0ri9l-------f -;k--------------Size,.?)(. ---Liquid depth........r------------ -Capacity.... No. of compartments_______ ......... Disposal Field: Distance from nearest well--- -Distance from foundation.o©.__:.....Distance to nearest lot line..... ......... 19 Number of lines.- r Length of each line......A4---!....... Width of trench._..-7.!Z' .................... material._..._.__of filter ma .... ....Depth of filter material-_______I --- Total length.............. ............... Seepage Pit: Distance to nearest well------ Distance und fWn Tf 'Sa it* on....Z#? ........Distance to nearest lot line................. CA 1KNumber of pits..-...:!7=---------Lining material.... ------Size: Diameter..... Depth....... ............ Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material.._____......__._.__._............... ❑ Si e: Diameter--------------------------------------Depth....................................................Liquicl Capacity............................gals. Privy: Distance from nearest well---------------------- --------------------------Distance from nearest buitcling.......................................... ❑ Dittance to nearest lot line-----------------------------------------------------------------------....... ......I...................................................... Remodeling and/or repairing (describe):........................................................................................................................................................ .......................................................................................................................................................................................................................... ............................................................................................................................................................................................................................ .................................................................................................................I----------.............................................................................................. 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 rules and regulations of the San Joaquin Local Health District. (Signed).................. ..................;W.04-on�- ----------------------------------------------------------------------------------Owner and/or Contractor) By:....................................................................................................................................(ritle)............................................ .................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... ....... ............................................. DATE...... . ............... REVIEWEDBY......................................... - -----------------------------------------------------------------............. DATE.. BUILDINGPERMIT ISSUED................................................................................................... DATE............................................................. Alterationsand/or recommendations:---------------------------------------------- ....................................................................................:........................... .....................................................................................................�:� ..... ...... . ----------- .................... ....................................... ..................................................................................................... -----------*------------ )....... 5--------------------------------------------- ..........................................................................................................................................................7za;6;6;��-•-.....-•-----•----•------•-•-•.--•-•------- ............................................................................................................................................................................................................................. FINAL INSPECTION -- --------------------------- Date.------..... ................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EN 9 REVISED 9.59 2M 5-61 ATLAS