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--�------rix��c,K�v: j - APPLICATION FOR SANITATION PERMIT Permit No. ...../.�..�l�S l ,G V (Complete in Duplicate) Dote 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TI N /Q >�� rwo ........... Owner's Name / ...- __...-•-----••-----------------------•-----------------------------------------... Phone Address------------------J�107-d- Contractor's Name------------------------�la.AAeee9/P.,1/`-------------------------------------- --- •----- Phone----....-------•----•---- Installation will serve: Residence [Apartment House ❑ Co`mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s Number of livingunits: .___ Number of bedrooms ___ Number of baths . I� �.�..cif:�r.;;�.......................... 1___ Lot size .... . Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 4�9 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (if yes,dote____________________) No 031`� New Construction: Yes ❑ No 8' FHA/VA: Yes ❑ No 9�— 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---41P____.Distance from foundation----J;Z----------Material.... �' -.-_ . . No. of compartments---,?-----------------Size.J.; �r s X4'A Liquid depth_•.! ---------------Capacityk i.�";i_—) Disposal Field: Distance from nearest well_..�_4"Distance.from foundation----i�2 ......Distance to nearest lot linee..r4 .l:.� [� Number of lines_______a - Length of;each line____ 1 � p-- width of french. --- ----- -------------- Type of filter material.!%�Depth of filter material----� � .----Total �ength___ft. .�,_.._._._._ Seepage Pit: Distance to nearest well--- Distance f�rm f�_ � ouf�dation_fl.�___._-.Dist f` to nearest lot line................. Number of pits......�r____.______Lining material___ QCa -Size: Diameter-.JY_.________Dep+h__ .._________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter-------------------------------------Depth----------=-------•----. ---------------------------Liquid Capacity-------------------_---...gals. Privy: Distance from nearest well---_--------------------------.___._'___._E_.__--_Distance from nearest building__________-----•---.•_•--_-______________. ❑ Distance to nearest lot line---------- ------------•--------- -------::----------•----------=------ t---4----Z....... • .. Remodeling and/or repairing (describe): �'� --------------------------I...........-----------------------------------•------...---•.......------............ >--_- •---•-- -- -•-----------------•--------------------••---•---------------------------------- -----------.... ........ ---------- -- .- ------- --------------------------------- -----•---------------•------------------------------------------------------•-•---------------------------------------------------------------•------------------------------------------ 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. ' ' - F V (Signed)...........------------- •----------- O� Contractor} By:......•-•----•------------------------------ -• --- ----••-••---......----...(Title). � -------------------------------- (Piot plan, showing size of lot, location of sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT-USE ON1011 A 4,Y APPLICATION ACCEPTED BY-,,,4- = ---- -- -- ------------------------------------------------------------- DATE.--� f�` � �------------ REVIEWED BY --- ------------------------ DATE ----------------- BUILDINGPERMIT ISSUED---------------•--------------------------------------------------•---•------•-------•--------------- DATE--------------------------•------.- ------ Fierions and/ ecommen ns_________________________ 1 s ------ --------- ----------- ---- --- K3Kac - - ----------------------�s i ..... `----- ---•----_..... ......•........ .......... --- --------------- - --- ---1------ ---------- . . ..= - -----_- ---- FINAL INSPECTION BY------ --- - -- ----- - -- - ------ Date---- --- ------------------------------ AN JOAQUIN LOCAL-HEALTH DISTRICT r 4 130 South American Street 300 West Oak Street`. ', 124 Sycamore Strut 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B•59 2M B-61 ATLAS