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I FOR OFFICE USE: - - -- ---- ------ r / ----------------- ------------:-------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....11 ------------------------------------------------- (Complete in Duplicate) -- --- This Permit Expires 1 Year From Date Iss Dote Issued .__..�l3,1��. `' �1 Application is hereby made to the San Joaquin Local Health District for a permit to n n I aif the work herein described. This application is made in complianwith County Ordinance No. 549. �� �I , JOB ADDRESS AND OCATION. _ --__----- � iPRr [-1�A ---------3�-TSA---- 1�LS ... ....0 ._kAllI�QP.---- Owner's Name---------J1N.,NJ./V&§�.�..-----•-----0-------------W1A-PIV---------JR..t---------------------------- Phone.-7R'.3.-n&07,67 Address._._. ...Y.�.....* --�,•___1...........M Tj�T .......................................................... -------- •------•----.----. --- Contractor's Name------.0—WKE-�-•-•--------•----------- ------------------------------------------•-------••------••--•---•-------. Phone................................... Installation will serve: Residence Apartment House.❑ Commercial ❑ Trailer Court C] Motel ❑ Other El Number of living units: ../--__ Number of bedrooms -- _L Number o baths .__. Lot size ........ .,r ................ Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table . ... ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam`❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) N�o� Z�'New Construction: Yeso E] FHA/VA: Yes [E] No SN TYPE OF INSTALLATION AND SPECIFICATIONS: NEW septic tank or cesspool permitted if public sewer is available within 200-feet.) Septic Tank: Distance from nearest well--4-WO__-_Distance from foundation....—JZ7.--..__.Mater'al. Fa'1F—D_W- -0-Q�....... No. of compartments,-�,,.�- Size._A/V-0-7.X-5.—r Liquid depth__..____________Capacity-_ Q.•.. Disposal Field: Distance from nearest well__S0_.._Distance from found ian.....A� ._.Distance to nearest lot line-. 5-.. �� Number of lines__ _____ __ __p________-____._Length of each IineQ .. __.Width of trench.___...4' f--7.0 Type of filter material:_. �.Q'4�,._.Depth of filter material.....__._Oir..___Total length............. Seepage Pit: Distance to nearest well----------------------Distance from foundation...0.....>.......Distance to nearest lot line..._......_..._.. El Number of pits______________________Lining material-----------------------Size: Diameter.......................Depth_____........__.............._... Cesspool: Distance from nearest well-----------------Distance from foundation----_____-_-------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 repairing (describe)______________ ------------•-----------------------------------------------------------------------------------.........................................................'----•--••------------------------------------ ----- ---------------------------------------------------------•---------------------------------------------------....--------------------------------------------------------------------.................................... 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. lj (Si gned) --------� -------------- y------------------------------------------(Owner and/or Contractor) B --•---------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------------------------- ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... -- _-__._-___ DATE-------. . �-- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE........................................................... BUILDINGPERMIT ISSUED..............................................................---------------------------------•---- DATE....................................... Alterations and/or recommendations:-_.__ ..... ..-f-----CIS(.......13&jCjK.A..... ------------------•-- ------•---- ---- ------------------------------------------------------------------•---• --------•-•----------•------•---------------••••--•--••-••--•-•••--•--••---•--•--••-•-•---•----••-•---•----••••---................................ --------------------- ------ --------- ---------------- FINAL INSPECTI a Date....----`-`.✓ ;,2.----------------------------- V� SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 Wort aStreet 124 Sycamore Street Oak Y 205 West 9th Street , Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS