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y -/---iJ� i r • 4 - -- -- -- ------- - ------- - ,z -1I -3----- APPLICATION FOR SANITATION PERMIT Permit No. . .-S12,47� ----------- --------------1�; 1"L-`7-------- 5-?i (Complete in Duplicate) / f ------------------ This Permit Expires 1 Year From Date Issued Dam Issued ... l- -J�--- )Application is hereby mad the San Joaquin Local Health District for a permit to construct and install the1work herein described. This �pplPC i Is made, - �mpjliance, ith County Ordinance No. 549. J BAD SS AN OC Owner's Name....... ------ ------------ Phone...........:........................ Address-----=----••-------`------- V X1_1 Contractor's Name---------- - --c._ - _- --- Phone, l _r� Q.��-• Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:!..._ Number of bedrooms X_- Number of baths �___ Lot size _._..._�. � - - ------------ ----------•------------•- Water Supply: Public system'❑ Community system ❑ Private Qepth ro Water Tablej._ ft. 1' i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 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: No from nearest well d Distanc�rom foundation,ja-'__.------.M erial_ . - --- o. of compartments---�-----------------Size_. a2_XV Li Liquid depth-----'•-- CapacityQ4 /� 9 ---------------- Disposal Field: Distance from nearest well•.---_._-.-Distance from foundation--14-_._------Distance to nearest lot line------- S- Number of lines__Q�_____ Length of each line_ �`_�z '.___.Width of trench:_:.. Type of filter material.- 1 f Depth of filter material--`Q_______..-_-Total length___________________ .. - L'- Seepag Pit: Distance to nearest s�well/0C'.._..._�_Distance from foundation__,l�?_-`-------Dista�e to nearest lot line_i__S_�_..- ' ❑ Number of pits._--oc------_------Linin. material -�, -•--� p ----Size: Diameter_._s�.�,.----------.Depth----��--•-----••-------- S Cesspool: Qistance from nearest well -----------------Distance from foundation-----_--------------Lining material,-----------_---__-__---.-_ - ---� ❑ Size: Diamete��,,- ----------------- ------Depth---------------------•------------------------------Liquid Capacity. gals. Y om nearest well---------______________--____----_•_---,----_-Distance from nearest building-------------------------------- ❑ Distance to Privy: Distance from lotline- -------------------------- --- -----•--------------------------------•••- and/or repairing P g �describe] -•- ..'�, a Remode m re ---------------•---------------•-------------- --------------------••-----•--•------••--------•----•-------------•-----•--•-•----•--•------.:.-------- 9 .............. .............>_..---------------------------------- ------------------------------------------------------------------------------------------------ _ ----•-----------••--------•-------- I he------------•-•---------------------- ---------•-------------------------------------------------------------------•----------------------------------------------------__----------------- reby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances at laws, and r and regulations of th an Joaquin Local Health District. (Signed)- --------- ----- nor and/or Contractor) - -------- --- ---------------------------- --- Y----------------------------� � ---------- Ti+le.. (Plot plan, showing size of lot, location of system in e_- relation o ells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__. - _. - --- - " ---------------------------------------------------- DATE-- r c _� REVIEWED BY__.. " ---- --- '' -------_------ - ------------------------ ------------------------- DATE--------•--------------•------------------------------------ --------BUILDING PERMIT ISSUED------=-----------------•--- DATE----------------------- ol/or recommend'a+ions:.-------- �'z-1--� tia '� �' xt'i- ' -�'c� c ' G��"� Alterations ¢.. c_- ---- , .� , --------------- ---•- 7t`ct- " - - '�J c� � .`i^� _ =j ----- --- -- -lam -- - 2 a' ; [i .��` - �------ do FINAL INSPECTION BY:----- :- ( ` r Date... " ------------------- --------------------- ----------------------- SAN -----;---------------SAN JOAQUIN,LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockfon,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8.59 2M 5-62 ATLAS