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FOR OFFJ�E Ute: --------- -------------------------- PPLICATION FOR SANITATION PERMIT Peranit No. .yl --------------------- --------------- (Complete " mlte in Duplicate) Date Issued _--- --------------------------------- ------ -- This Permit Expires 1 Year From Date Issued Application is hereby made to the SanJoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance.with County Ordinance No. 49. JOB ADDRESS AND LOCATION______ 11_9_--3-/__®___________________________ _ 4—L -Owner's Name..... .... --------- Phone------------------ -------------•------ 0�1 Address.--•--- ---------------------------------•------------ -•-------•-------------------- ------.--••----....---- Contractor's Name ., .0 Phone ---------------------•-------____----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..I---- Number of bedrooms -3--- Number of baths -1---- Lot size ----197-1 /A�E. Water Supply: Public system 2--l-6otnmunity system Ej Private ❑ Depth To Water Table __40ft. Character of soil to a depth of 3 feet:: Sand ❑ Gravel (] Sandy Loam ❑ Clay Loam ❑ Clay El Adobe[t-�H_ardpan ❑ Previous Application Made: (if yes,date--- -------------) No 5K New Construction: Yes Q No FHA/VA: Yes ❑ No ®� r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept" k: 0 Distance from nearest well_________________Distance from foundation--------------------Material_____________-__-_________--_-________________- No. of com artme,nIts-----------•---------.----size--------------------------------Liquid rde fih-. --_------------------Ca Capacity ---J-• --••--- DDistance from nearest well-— Distance from foundation_w_-------------Distance to nearest lot line____-_-__-' apt $ Number of lines _:_1______________________Length of each line___. d_______ _..._.._.Width of trench_ �'. __ ____.__._._......._ Type of filter material`_1�k(,_X-____-__Depth of filter material---/'r_.-----------Total length------•_S__�2........................... Seepag Pit: Distance to nearest well----- ----------Distance n foundation_JO............Distance to nearest lot line__Lf?__......... Number of pits....:_---r----------Lining material------- ----L- -Size: Diameter---33_--�------.Depth----;:&371�-------------- Cesspool: Distance Diameter nearest well- _ ________________Distance from foundation-------------------- material------_-_-___-___-__________.------ ------------------------------Depth---------------------------•------------------------Liquid Capacity----------------------------gals. r __Distance from nearest building Privy: Distance from nearest well------------------------------------------ -- 9---------------------------------------... ❑ Distance to nearest lot line------------------------------------- ------- -------------•-•----•-- ------------•--------------------------•------------ ------•-------- " Remodeling and/or repairing (describe)---------------------------------------- --------•--.......•-------------------------------------------------------------------------------------------- ---------------------------------------------------------- l a I hereby certify that I have prepared this applicatio and hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations oft an oaquin L al Health District. (Signed)---•--_----•-------------- _- ---------------------------------------------(Owner and/or Contractor) By� '------------------------------------------- --------• - (Ti+le) (Plot plan, showing size of lot, locationof system in relation to w Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPT BY--./--.._____ _ _ ____ _ _ - -- ----------------------------------•--- DATE.... +- ----•--------------- REVIEWED BY--------------------------------------- ------- -------------- ------- ------------------------------------- DATE--- .............----•-------- BUILDING PERMIT ISSUED............... ✓ .._.. DATE --------------------------•---------•- Alterations and/or recommend'a+ions:_ -_-- __ .----------•.-------- I ________________________________________________ •___-..._-_____ ___._ _ _ _--_.-------•------------.-.._ ______--_-__--__-_-__-_..---.-.----________-___-_-__--___-_-____________________-__- .................................. ..-.. _`_.- ------------- _ --------------- ..._-._.-.---------------------------------------------------- FINAL . -.._____-____-.___-_-___.____ ___-_____.___FINAL INSPECTION ------ ------ -- --- --- -- -------- ..... ate- � I S N JOAQUIN LO L HEA DISTRICT 130 South American Street 0 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISEo a-s9 2M 5-62 ATLAS I