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rUlc UI.1'ICt Ut: � --------------- r'! `` --.--._-__-. APPLICATIONFOR=SANITATION PERMI 4 � Permit No. .. -------------------- - -------------------- -- ------------------------------------------ -----------•-- (Complete in Duplica+e) `- --- -------- ------ This Permit Expires 1 Year From Date Issued Date Issued ---�,1... ---_C 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. JOB ADDRESS AND LOCATION_._.I - - �- � --- --- ----------- ----------•------------••----------•-•--............................................ Owner's Name ------ Phone. Address................ - / - ----------------•--------------•------------•--•---•----- Contractor's Name.- .... !�Q/L. _ •�. �„r�- _� ; 1 Phone.............--••------•-• Installation will serve: Resident [+]`Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ Number of living units: -_I__- Number of bedrooms ._J_ Number of baths __.,/_ Lot size ---------5- Cl--._V -2--_�.___ Water Supply: Public system B -Community system ❑ Private ❑ Depth To Water Table3_a ft. Character of soil to a depth of 3 feet: $anGrave ❑ Sandy Loam El Clay Loam B-�-Clay ❑ Adobe C3 Hardpan ❑ Previous Application Made: (!f yes,date- __ td --.----I No ❑ New Construction: Yes ❑ No [--+HA/VA: Yes ❑ No B— j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tyank: Distance from nearest well-----------------Distancd from foundation-_-_-- " ------•---Material I /1 No. of compartments_-..----------- •-- Size--------------•-----Y-----=---Liquid depth------- Capacity -------••------------•- Distance from nearest well-_._---? -.-_Distance from foundation ._ _✓"`....Distance to nearest lot line---:--- � AA Number of lines________________ __ __- --- Length of eat `line""_•. _ _--_--•Width of trench..--__-_-.__ --� �+ --------------- Type of filter material.-.-._ -__s .De fh'of filfr material--.-.� -- length--- e04 pTotal 2 r-' Seepage Pit: Distance to nearest well fro foundation--.. -.�� 7 w a �!-.____-_-_.Distance to nearest lot line-------=--------- I Number of pits-----V--_----__-Lining;material-__- ice -Size: Diameter---3,_ ___ '--_. -- � Depth--------`i---�-------------- - _ Cesspool: .- , Distance from `nearest well----------- _ pis#ante from founda#ion---.--_--- `___---.Lining materiel_-..--__ , / - ---•-----------••------------ V+ ❑ Size: Diameter " {-----Depth-- - k -`- __-'�- Liquid Capacity gals. Priv M� - ' y: Distance from nearest well-------- -------------- - , , _ -------------------_tiDistance from nearest building------------._-:-------------------------- El Distance to nearestlot line----- --------------------------- Remodeling and/or repairi d scrib ) --- ------- - � � __ r�r.Rls • . . ordt% #dt Aeby certify that I have r ion and that the work willdone in act rdance w' h San oa in Counfy inances, State laws, and rules a re uatigns of the San Joaquin Local Health District. c_ • , - (Signed) . � -------------•------------- --•----- ---(Owner and/or Contractor) gY: •of-----,.-------------- � - -------------------------- Title )-- ---- --------------- (Plot plan, showing size of lot, location of s sfem in relation•+o wells.,-'buildings, efc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- �2�e DATE -------- ----- .......... --- ----------------- REVIEWED BY ------------•---------'------- --- --------• DATE ---•-------------------------• -- ---- •---------•--•--------- UILDING PERMIT ISSUEp4_-- - --`-. DATE---.---.- Alter ions find/or recon 'I ions: �.= _ •-- = = 1 --------------- _sem.,,--...- FINAL INSPECT�t�BY:.-_--.��( 3-------- . Y-. ---� �7 Date----------J�� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Well 4dk'�Yaat 124 Sycamore Street 20S West 9th Street Stockton,California Lodi,C 1lfornfa Manteca,California i Tracy,California E5 9 REVE5ED 8.59 2M 552 ATLAS