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FO FFI E USE: 4c.�w �70�3 / ., --.',- _---------------_-_-_- '------ ----. APPLICATION FOR SANITATION PERMIT Permit No, l --------------------------------------------- --------- [Complete in Duplicate] , This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOS ADDRESS AND LOCATION---7:!�_,_/-J�--�_�?•O //� • -------------------------------------- -------...----------------------•------------ Owner's Name 1/( Phone 40 ---b---'131 Address----•------------•- C ----------------------•--•-------'----------•------•------------------------- -= Contractor's Name...--•-----------a(tr._ .---------------------------------------------.--------------------------...---_-----------------_-- Phone.Z.............................. I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other.❑ 7S X Number of living units: .-_1 1 Number of bedrooms _3_�_ Number of baths ____I_ Lot size ------___ _________/_a..,_._3 ._..______.........._ Water Supply: Public system jo ,(Community system ❑ Private E] Depth To Water Table 60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[W Hardpan ❑ Previous Application Made: {If yes,date___. _ .� .] No New Construction: Yes ® No [4 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest r •-w- e-ll-_ y-rX ._.Distance-fromlou-ndation.......&------ .Mate iiaL.. Na of compatmen#s--- -- �--. Liquid-deh-,.....------ -� . . Ccm Capacity__ tY-- Disposal Field: Distance from nearest well��'#i&--- f- Distance from foundati n.-_---_ ..._.Distance to nearest lot Ilne____ Number of lines--=---------------Z-- - Length of'eaeh Fine--- f_ -�P_.Width of trench •----_- �.- t Type of filter material._.- -- -- ._-Depth of ....Total length------...-__ _ j ----------..---- �i � s Seepage PT: :` Distance to nearest well-_-� __ *Distance m, ou dation_; .___ Distance to nearest lot line.-___--/._.... Ill Number of Its ----/777!__Linin material--------- -- -------Size: Diameter-------, ,�--------.Depth_-._..-_!�g,$'.!............. Cesspool: Distance from nearest-w-11------------------Di'stan rom foundations ----..---.Lining material------------------------_--.----.--- t-- --------------------Depth---------------------------•----•------------------Liquid Capacity-------•-- --------------•-gals. VT Priv Distance from ------------ nearest building---------••---------•-•--••--------_.- ._. ❑ Distance to nearest lot line-- ---------------------!,r$------------------------------••---•-•-----•- f ---------------------------------------- Remodeling and/or repairing (describe)--------------------------- -'-----------1_4-------------------------------------------------- ------ 4-------•_•----------_- --•--- .---- I 1 01 ) ------------I-------------------------------------------•---•----------•----•-----•----•-- �'1"r` , t -•---------•---------------••---------••-------------------------•---•-----------.-----•-------------------------- •-------------------------•--•----------•------------------ ---------------------------------------------k --------^tib____ ____--•=_____--__-.. ------------------------------------------ I hereby certify that 1 have prepared this application and thatthe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San JoaquintLoial HealWh�District. I { t (Signed) -- �- ---------------------------------------- ---------------------- - i -----•--------------(o l � F , caner and/or Contractor) gY: ----------•`-•------ =�={'-•#[Title) ------------•---••- -------------- - ------- c plan, showing size of lot, lo,c ,on of sys+emJn relation to-wells;buildings, etc„�cen be placed on reverse side). r L 4fFOR DEPARTMENT USE ONLY: * ? APPLICATION ACCEPTED BY-----:, -z-�•__-- -a�4---- -- - •------ DATE' = REVIEWED BY � l ----------=--- -*'..-------- DATE BUILDING PERMIT ISSUED------------- ------------•---- k �• - ' =,.DATE Alterations and/or recommendation':_:--__- -- -- ----------------------------- -- . It - . -7 -- == .. - - - rz- -�_ % j'p ------------ ----------------------- FINAL INSPECTION BY:----- r -----•----------------------------• }.r Date----- a4” -------------------------------------- , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 134 Sycamore Street 205 West 9th Street Stockton,California Lodi,Call fornia Manteca,California Tracyr California ES 9 REVISED B-59 21A S-62 ATLAS f