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FUR OFF CE SES �u f/ r - --- ----- -- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. z _.__. ....-. .. --------- •--------------------------------------- (Complete in Duplicate) - ------------------ ---- ----------------------- -- Date Issued . This Permit Expires 1 Year From Date Issued 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 complian' my Ordinance No. 549. JOB ADDRESS AND LOCATION......17 Owner's Name- -----eeciti,----- � -- Phone Address .....3.S..... . .•.-- 7"''35 - - ---------------------------------------•--------- Contractor's Name--------- .. Installation will serve: Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---t--- Number of bedrooms _ Number of baths ---/--- Lot size ---6 �-. 1. --____-•__„-.- Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table .kq ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan 0 Previous Application Made: (If yes,date--------- ----------) No P?r” New Construction: Yes,f No ❑ FHA/VA: Yes ❑ No n--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank- Distance from nearest we_•— _ r I� Distance from foundafiion._JQ------------ material-__1'6-�' rra'a -----------of compartments-...__-____.--------------Size_.._ --XS__ -_"-,Li-.--.Liquid de fh....�..-_-_ _ Ca Capacity__ �a�` q p P ty__ --- Dispos Field: Distance from nearest well ------_Distance from foundation_.�a_�__"_.. Distance to nearest lot line_.'_.`.....__. Number of lines--4 _ ____ ________---_--.---.-Length of each line._._... _ - " g Q Width of trench...`' 'Y---•-•----------------- Type of filter material.,.-. l+t..__.Depth of filter material.-_It---:_�___-___Total length___---9..z"._� -••-----•--------------•- Seeps Pit: Distance to nearest well._,'_.`..__-_____Distance�m foundation__eg......_....Dista4pce to nearest lot line....�r�... Number of pits.".. ....."-"...__.Lining material-_. _ _(�fl___-.Size: Diameter.--3.+ .._. ...-__.Depth-------- 4- -------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ ` . El Size: Diameter----I-------------------------------Depth.-------------.....---------------------------------Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line_-- 9 Remodeling and/or repairing (describe):_..._ ---•---•-------•----•------•-•------••------•----------- ----•---------------------••---------- he ti -- - - ------------------••----••-------...----•--•-------------------------------------------•- I hereby certify that I have spare this appli ation and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rul nd r guiations the San Joaquin Local Health District. (Signed)------------------------------------- -------------- ---------- -------------- -------------------------------------------------- and/or Contractor) By:................... ----- - I_ - ------..... . ------ {T'itle) j (Plot plan, showing size of I , location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - ' - -- - --- - --- --- -- - - - DATE..-�---- ------ --- REVIEWED BY------------- ------ DATE--- - BUILDING PERMIT ISSUED---•------------- -- Alterations and/or recommendations:".. ctxi.-- ,mss.. ..... 2 jam;.". -----------........5;. C ff --------------- J sir ". �...." .... ......�.�.." ". .. 1.5 �.. �•..� -� 8f 3�G f�u-udt Isco o� /yl� G.•.�_ FINAL INSPECTI N Y:....._.."___.___.. _•_�� _ 1-44W SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Ameri300 West Oak Street 124 Sycamore Street 405 West 9th Streef Stockton,CaiiforniW t Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS