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FCR OFFIC USE L- _ - - APPLICATION FOR SANITATION PERMIT P�mit No. .......7 ....:� z--r / ¢'-1 PA (Complete in Duplicate) 3� / --------------- k - This Permit Expires 1 Year From Date Issued Date issued �-___.__1_�� ______ ._ ..4? .10 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This aftplication is made in compliance with County Ordinance No. 549. ir JOB ADDRESS AND LOCATION------ 1`1-2.G.e aed---------�T G,le,;g, `��.�..'.....----••-•------- Owner's Name--------- �,/za_Aez. .v--------------------------------------------------------------------- Phone.................................... Address.- �/�/• ....- ........ ...........•-..................... .J Contractor's Name.- - -- ---- � .G..I �T d.�+ .� -------------------------- Phone/-----4r.AfeD , Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ Motel [3 Other E] Number Number of living units: .�__�umber of bedrooms _ Number of baths __-_- Lot size ....... .................... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .4/oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: lif yes,date--------------------l NoX New Construction: Yes ❑ NOX FHA/VA: Yes ❑ No ❑ TYPE EDF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,1 Septic Tank: Distance from nearest well__�WCDistance from foundation.----149---r_.Material------- ....... No. of com artments-.-._ Size_ '1�__" ._._ Liquid de th_. `� Ca aci Q.Q�.__..... 1 Disposal Field: Distance from nearest well_�{� -Distance from foundation../Q-----------Distance to nearest lot line.-.a.......... Number of lines--------.-___ --------Length of each line_____��_--_--__.Width of .................. �............. Type of filter material._._ Q_C -.-Depth of filter material______ _ _ __ __Total length---_-____g_0.-......_.._....._...__ - ri \ Seepa je Pit: Distance to nearest well..�W_n) c....Distance from foundation-,-,IV-----------Distance to nearest lot line___1dr ANumber of pits------1_____________Lining mate ria l__.,l�p�l�_.Size: Diameter__„Ta_ f_.__..Depth_____��-.`_.........._. Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material-------------------------........... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well-----------------------_-------------------------Distance from nearest building-----.-.________________-_.___-________. ❑ Distance to nearest lot line______________________________ __ Remodeling and/or repairing (describe)----------------------------------------!----------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- --------------•---•-----------•---------------•-------------------._...----------------------------•---------------.........-..-------------------------------------------------------------------------•-..._.----------• -- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, an regulations of the n Joaquin Local Health District. (Si ned 9 ) L -.. .. - = -------- caner end/or Contractor) By:-------••----------------------------------------------..... ...- --- (T'itle)----- ... l - (Plot plan, showing size of lot, location of system i relation to wells, buildi , etc., can be placed on reverse side). '. DEPART ENT USE ONLY APPLICATION ACCEPTED B --- �--------------------•--------- DATE �..-r^�.�_.�-.�' �--�---------- REVIEWEDBY___._... --------------------------------------------------- DATE-----------------••-• ----------- I BUILDING PERMIT ISSUE --------- - ..._._.... -w------- DA' E a - ------------------ Alterations and/or recommendation s:. __-02.1 .•- --Z---Jr --- -_--- l C c ae .? �1 ---..pA`.. ------------ . -zap- �- 4.��r_ .__.�-},,Q. •> --... ----------------- --------------------- ------ ------- ------- ------ FINAL INSPECTION BY:.---- • --- --..... / Date--------- — �_ .LO. ------- S -----' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street V Stockton,California Lodi,California Mentees,California Tracy,California ES 9 REVISED 0-59 2M 8.61 ATLAS