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P-yr 11�.r- vor: 1 - - APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 4 This Permit Ex fres 1 Year From Date Issued Date Issued ....��- 34-3 Application is hereby made to the San Joaquin Locai Health District for a permit to construct and install the work herein described. This application is made in compliance with Cppounty Ordinance No. 549. JOB ADDRESS AND OCATION..___-�G�-__� 0 ------ - -R 7 Owner's Name_.._ f -------- Address......-------- �fft ® (' •. Phone.... -- ----- •-----•---------------- Contractor's Name............ ��.5 •-------•---------•---------•--••--- •-------- --• ••----•-•--••------•--- Phone------ Installation will serve: Residence I" Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑� Number of living units: /-__. Number of bedrooms > .- Number of baths _-1___ Lot sizeX- --• - ' �•--""--"-•'Weter Supply: Public system Community system •---.-- - ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe0/Hardpan ❑ Previous Application Made: (If yes,date----------_- ) No ® New Construction: Yes [] Noe' FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Talk: Distance from nearest well //�� / 11,61 � �/ �''�[}istan from foundation- ---.Mat r�l._ _p'�,Q41-_ No. of compartments_.___..--•--- ---------Size---:4-- Liquid depth------- Ca aci EGD' A/ , P tY----------•- Disposal Field: Distance from nearest welll�l�Distance from foundation__�d_______•Distance to nearest to Iir�e... �. 21— Number of lines________________ ____ _____ __Length of each line---•-------- Width of trench- Type of filter material... a --• -- - --Depth of filter material-__-49-----Total length.---- ¢- .._____•_ Seepage Pit: Distance to nearest well_____________________Distance fin foundation... line.. Distance to nearest lot ..........._.- Number of pits_..___.___.-___--Lining material__.___.. _ __ Size: Diameter,--—3--,3--".''� 3- Depth------ 5-..-------------- . Cesspool: Distance from nearest wellDistance from foundation--------------------Lining material_.--------- .._____-____..__-___...___ Size: Diameter - - -------------------Depth----------------------------------------------------Liquid Capacitygals. Privy: Distance from neardst well------------------------------------------------Distance from nearest building--- F1 Distance to nearest'Cot line_--._""_____________ �� ----•---------------•----------- Remodeling and/or repairing (clescribe):__`_,r��Q-•� - - - -----•-----------•• -------------••-----•---•-------`•----------- - ...------------------ •-------- ---------•----------•----------•--••------- -----••-------- •--•-----------•----------•-----------•-----------•----------••---•------------------ ------------------•------•----•-------••---•------------•------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, �_afews, a r and regulations of the S quin Local Health District. (Signed) �s, --- J ---------------[Owner and or Contractor -------------- / actor By:.-------- rifle (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F RD ART NT U ONLY APPLICATION ACCEPTED BY- ------_._ -- - - ---- --1 -- ------ ----- -- •----------------------- --------- DATE- VIEWED BY--------------------------------------------- ................... --------------------- ------ DATE BUILDING PERMIT ISSUED_.____...._________ ------- Aiterations and/or recommendations:--- .. DATE.__.--_•----••---__-- --------------------------------------- FINAL INSPECTION Y DateP`.��/ :Z-- -- ---- ------ -- SAN JO UIN L CAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodl,California REVISED 8•S9 YM S-fil ATLAS Manteca,California Tracy,California E8-�