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rvKvrrll-C U=: ------- --------- - - .--3- -.3-41i,-- ;-v ! APPLICATION FOR SANITATION PERMIT Permit No. .1... . .. ------------------------ _--!/_3 Q. (Complete in Duplicate) ------------------- this Permit Expires 1 Year From Date Issued_ s, Date issued -J-_...21L - L 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 compliance with County Ordinance No. 549. f JOB ADDRESS AND LOCATION ---•-•------------- --'----------------------•-------------------------------------- Owner's Name--------- � �EI ------------• ,t Address-----------wx'a.47.4a .......... :_.. Contractor's Name-----•----•-- � ----.....:-------------- --------•----•-- Phone................................... + t Installation will serve: Residence Apartment House [j Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___ Number of bedrooms A__ Number of baths f____ Lot size "X_ ---6,0 Water Supply: Public system ❑ Community system ❑ Private g?"'bepth to Water Table .49 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9?"A�ardpan ❑ Previous Application Made: (If yes,date____________________) No Peo", New Construction: Yes 930"no ❑ FHA/VA: Yes 2?,�7Jo ❑ 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---AM-_..Distance from foundation__ -------Material_,&, ------------__ UK No. of compartments ___ _ ��.r�` � ..Li Liquid de th___ Ca aci ...... P �'.................Size-- q P ��s'�----------- P tY-- -•--• -- Disposal Field: Distance from nearest we€I--/PO..._Distance from foundati n...A9........Distance to nearest lot line.s'I�___..... ®/ Number of lines....._/_-___-_ --_____ ,,,,------,,�Length of each line____ - ` Width of trench__ -_-------------------------- If Type of filter material�� - *Y—&epth of filter material_._. _�_______7ota1 length...... ' �_____________ _ ______ Seepage Pit: Distance to nearest well__,t e_._.___Dlstance from fou dation•...C�..___.Distance to nearest lot line_"------- Number of pits----/-______________Lining material.,404�.Size: Diame+er__tf% �.__...___Depth- Distance from nearest well_________________Distance from foundation--------------------Lining material___.___•-•---__-___-.-_--___-____._-_ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well_________________________________-______ -------Distance from nearest building-_____-____________._.-------_...._..._.. ❑ 'Distance to nearest lot line---------------------- •------------------------•------------------- -------•--- •' ;> - ------•-•.---------f---------------..... ........................... 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 and regulations of the San Joaquin Local Health District. (Signed) -----------•-- •--------------------- or Contractor) y y------------------------------------------------------------------------ eevwr, •------__ ---.drtlel - (Plot plan, showing size of lot, location of system in re on to wells, buildings, etc., can be placed on reverse side). FOR DEPA MENT USE ONLY APPLICATION ACCEPTED BY - ------------- y - DATE_ . "...�Q REVIEWEDBY---------------------------------•- ------------ - •-•------------------ DATE------------------------------------------- BUILDING PERMIT ISSUED-------------------------------- -,.....•---• ----------•-------------------------------- ........ DATE------------------------------- Alterations and/or recommendations:--------------------------- �Y _ --- ---- - - - ---------_._ �4 ._.. ................ FINAL INSPECTION BG~ . ---- Date.----1:10-1��- ---------- ----------------------------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 4;� �� X124 Sycamore Street. 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Eli 9 REVISED BrS9 2M 5-61 ATLAS 1