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FOR OFFI�E,,USE: ------- -----------/, APPLICATION FOR SANITATION PERMIT Permit No. ..... 1.. .. __.. ------------------------------------------------------- (Complete in Duplicate) (� v _____________________________ This Permit Expires 1 Year From Date Issued Hate Issued ... Application is hereby made to the San Joaquin Local Health District for aipermit to construct and install the work herein descrbed. i This application i made in compliance with County Ordinance No. 549. / tY lot eta Y, rs�. � /r•lv�-✓ 9� JOB ADDRESS AND�L'O1CAT�ON j �1 � r /. -� - '-- -- ----1 s.v �✓ Owner's Name------- •._...... ----------j ---•---- -------------------------------------- Phone---•---------•------•--•--••-----•-- Address------------ -f---}-- ------ •----r - ---------------------------------------------------------------•--------------....._....:...--•-•-....------------------------•-- Contractors Name------ -------- - - --Q e? G✓ Phone � --•--- Installation will serve: Residence /Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._____ Number of bedrooms _J__ Number of baths,.___ Lot size .. _C J -_____________________ Water Supply: Public system ❑ Community system ❑ Private CRI"D—epth To Water Table a5_Z.j#. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe r04 ❑ Previous Application Made: (if yes,date_.-------------------) No W-"'New Construction: Yes ®,,�o E] FHA/VA: Yes Flo , r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) I leIC� I Septic T Distance from nearest well.,rZ__r___Distance from foundation._./-4---------Material-----CQ.-._:�................................. No. of compartme Size------•-------------------------Liquid depth--------------------------Capecity.j�4 Disposal Field: Distance from nearest well__tsSt�- -___.-Distance from foundation---,/_._________Distance to nearest lot line._.S_____....: Number of lines--------s;;�-_--------------------Length of each Zine....._. t' Width of trench. Type of filter material.-) of filter material---/. �---------Total length------ ..._______.......... Seepage Distance to nearest well_,�4'a._ ____Distance from foundation___.�Q...�____.Distance to nearest lot line..4...... E�' Number of pits-ZZ- -----------Lining material______ Size: diameter__:3_J.............Depth_-_-a5----!-------------! � Cesspool: Distance from nearest well_~------------_Distance from foundation--------------.___..Lining material___.-,_------------..........._... � N ❑ Size: Diameter------- ------------------- ....Depth----------------------------------------------------Liquid Capacity----------------------------gas. ,J Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.__________________-__________.___.-__.._. ❑ Distance to nearest lot line--------------------------------------------- -------------------------------------------------•--------•-- '=----------- Remodeling and/or repairing (describe)------------- 'Lf .._. - - -•----••------••.......... ' •-•---•-------•-----•----------•----------------------------------- --•-----•------------------- ---------------------------------------•-----.._.-------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an egulations of the San Joaquin Local Health District. (Si ned Ii - 9 �------------- ---------- �• -- ------- -�-- ---�----�------------ --- --- - - ------------------------- -•-----(Owner and or Contractor)_..----•- ----- --------1�- ___ - c ___ [rtle) �� ----------- (Plot plan, showto , location of sys+em in rely+ion to wells, uildings, etc., can be placed on reverse side). FOR DEPART T USE ONLY APPLICATION ACCEPTED BY----------- 01 --. ----- -- ---•------ ----•-------•---------------- DATE-•------/ --fig -------------------- REVIEWEDBY------------------------ -------- - -------------------------:--------------------.-------.....-------- DATE----------------------------.------------------------ BUILDING PERMIT ISSUED --------------------------------------------------------------------- DATE. Alterations and/or recommendations:_--___ _ ..__ _ ..-c.,�____.___ .��-_ l _..-._ -•-------------------------------------- --------------------------------------------------------------------------------•--•-•----------------------------------------------------------._...............••----••---------- ._.....---"----------------------=-----------------------.--_---•--------------------------------------------------- ------------•- FINAL INSPECTION BY:.--�-f"�_--- - ____-.'�------------------------------------- Date----�-----------------------• --- •---------------------------------------- SAN ----------------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISER 8-59 2M 5-62 ATLAS