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t FOR OFF US = ` A144 ----- ------.r�'" (Complete in Duplicate) APPLICATION FOR SANITATION PERMIT Permit No. . .............. . �J "` .__._...._ .. ____ __ __ __ _ • This Permit Ex fires 1 Year From Date,lssued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to struct nd install the work herein described. This application is made in compliance with County Ordinance No. 549. t co7V -, P C---Z �3 JOB ADDRESS AND LO TION._- -- s ___-_-YA-4Y-- ---------- ------------- Owners Name ........ . Phone--------------------------------•--• Address------- tr• -----••... ............. -----------------------------------------------........ --- ----- - ------ - Contractor's Name---------------------- - -.::. x ....... Phone - Installation will serve: Residence ❑ Apartment House ❑ Commercial� "F1'Trai er: in [I Motel [_1 Other Number of living units: ________ Number of bedrooms _______ Number of baths,____ Lot size .....1ST-,,25770..................... Water,Supply: Public system 0 Community system ❑ Private ❑ Depth To Water Ta bl.--•• t. Character of soil to a depth of 3 feet: Sand ❑ Gravel�❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe PyHardpan ❑ Previous Application Made: (if yes,date____________________) No ❑ New Construction: Yes No ❑ 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 well__5._D_____Distance from foundation_1. _._.:___.Mat tial..__ ......................................... _ No. of compartments------ ------------Size---3X K—!� --------Liquid depth---� "'.----------Capacity.... . .` Disposal Field: Distance from nearest welL._g d____.._Distance from foundation..,5.____-.._Distance to nearest lot line_ _-___�% Number of lines......__-_______--_�,__-_Length of each fineti.l�_ ____SQ-_.....Width of french------ _.----------------- _ _______�_____.� Type of filter material._._- R.��k-Depth of filter materiaL.Zey_,_ _.1....Total length......................Ra ------J Seepa�9e Pit: Distance,to,nearest well-z-, .Q_..___.--Distance frpm To riclation__4/—'!-...Distance to nearest lot line_:S_.- ® Number of pits-``-c =- Lining meterial__G = ` Size: Diameter-- Jj-- Depth Q �f Cesspool: Distance from nearest well----------___....Distance from foundation---------._______.Lining material----------------------------.__._._-_ ❑ Size: Diamete}r--------=----------------------------Depth-----------•------------------------------------1---Liquid Capacity----------------------------gals. Privy:' Distance frominearest well-------------------------------------------------Distance from nearest building_--____..___-__.-.-.._-.-.._-_-..._._____- ❑ Distance to nearest lot line------------------------------------------------•-------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):---------------------------------------------------------•-----.....----------------•--------------•----•---------•---•-------------------------------- T ----••--------•--•-•-------•-----------•-•--=--•------------••--•----•-•-•----•-•-----•-•--------_--•---•----------------------------------------------------------••------------•---------•-•--------------•------------ ------------------------------------------•-------------------- - ---------------------------------------------------------:------------------------------------------------------------------------------------------------------------------•-----•- -:------ ------- I I hereby c"that that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, St to [ s, and ru!es and regulations of the San Joaquin Local Health District, {Signed} r ---- ---------------------------•----------- ••--- wner and/or Contractor) g . ----------- ----------�------- r+le y - - - (Plot plan, showing size of lot,'location of system in relation wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----� --------------------------------------• - DATE... 4= Z 3 ----------------- REVIEWED BY-------------------------------------------------------------------------------------------------------------------------------DATE.-----------------------------------• - - ------------------- BUILDING PERMIT ISSUED----------------------------------------------------- ----- DATE------------------------------•------------ ---•---•----- Alterations and/or recommends+ions:Q_' � '- '.___--.1. ...i_K.s._. ►'` / � ------ z ----$--k--� aR. '� .5 ................. .,_ - ------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------•-• ------- -•---------------------------------------------------------------- -------------------------------------------------------- ------------------ -------------- -_...._.-------- FINAL INSPECTION BY: e- ` •-------------------- --------------------------------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Strut , 300 Wast Oak Street l N X124 Sycometo Street 205 West 9th Street Stockton,California Lodi,California Manteca,California' Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLASs