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FOR OFFICE USE: I F/4 11 J. ----------------------------- �► ^� / APPLICATION FOR SANITATION PERMIT Permit No. .. .. -�" ----- ------ (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 compliance with County Ordinance No. 549. 650 �]5 JOB ADDRESS AND LOCATION-L. ._�R'-----1---kes.ca—r7. Owner's Name-------- �TT�� - ------------------------------------------ -•- Address.----•------•-YrL .. _�... ._ R '.-.------------------------------------- --------------••..................................................... Contractor's Name--. --•------------•--------------- Phone.------------•--•--...------•-- ... ,� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._-_-- Number of bedrooms .�_- Number of baths _/.-�1'ot size -.-_-tD------��_��ss__f....... .-.., Water Supply: Public system [_ Community system El Privatepth To Water Table - eft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam 8->Y ❑ Adobe❑ Hardpan Previous Application Made: (If yes,dote--------------------) No 0l�lew Construction: Yes I, .No ❑ FHA/VA: Yes ❑ o TYPE OF INSTALLATION AND SPECIFICATIONS: -4. � -- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well_-D----..Dis}a ce from foundation---�Q----------Mafi rial--- - .L----- C No. of compartments..- �-_-_-..-.--Size__Z3x_jX!5.--_Liquid depth------- -----------------Capacity.....9QQ-_-.,. Disposal Field: Distance from nearest well__5_0...Distance from foundation---.,� -- D stance to nearest lot line_--_ ---------- �� Number of lines--- - _ � Length of each line- :x '--- -t ..Width of trench----- ..�._ Type of filter.material.. . 2�- ==:.Depth of filter material_=__ --------Total length............le-d------....... ----- Seepage Pit: Distance tornearestwell---------------------'Distance from foundation--------------------Distance to nearest lot line--------.--- --- ❑ Number of'plts.,-------• ---Lining material-----•----------I-----Size: Dia"meter----------------- Depth-------------------------------- Cesspool. Distance from nearest well-------------s.�Distance from foundation-------------f------Lining material----...---------__---__-----__'.--_. ❑ Size: Diameter--------------------------------!!!�jDepth------------------i--- ---------------------- -----Liquid Capacity...............------------cgals. Privy: Distance from nearest_well-____._-.------------------------------- -------Distance from nearest building----------------------------------------- . ❑ Distance to nearest lot line...----- --._;-_-_.- Remodelingand/or repairing (dbL;6e)---------------------------------------------------•------------------ ------------------------------------------------------••------••-•--•---•---.----- I - -----------------------------------------------------------------------------------------------------------------------------------_----_ ------------------------------ ------------------------- --i...--_-_--_----__-_----_•_-_.--.-_-____-____-_----------_-----_-_-_---____----___._--_--_____-__---._-.-._-___----.____---...-._------------------------.-__--.--- I hereb certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a s, nd'�ules ah�regu�la+ s' of the San Joa in Local Health District.{Signe --- ---- ....... ..... - --- --- ----------- -------------------------- - (Owner and/or Contractor) -- �. - i y�---------- `- '. .. :-_.-: "= ' = )Title) -= (Plat plan, show r.q size of lot, location of'system in relationJo wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------•�} �-Q------------------------- -------------------------- DATE , L.Z. REVIEWEDBY--------------------------------------- ---------------------------------------•----------------------------------..._.- DATE---•------..-_---•----------------------------` BUILDINGPERMIT ISSUED......----------------------------------------------------------------------------------.._-----.-. DATE..................... AFterations'and/or recommendations: _.., .,. -� -t- -----------•-•-•----•-------------�-•-----...----------•--------------`------ _ . _'CLf f` f FINAL )NSP ----- Date--------/ - `�- — 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 REVISED 8-59 2M 5-62 ATLAS /