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FUKOFFICE U5E: rL ... ------------------ APPLICATION - APPLICATION FOR SANITATION PERMIT Permit No. .-.-!. .`�_q /!a_� __ -------- -------------------- - F.^y�---:�• - (Complete in Duplicate) ._ ------ This Permit Expires 1 Year From Date Issued Date Issued -.-q._'S................ 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 A TiL_ -��.------ f✓Y- •-(,t--l/dl .&l.....__.1- - .0 '' .� Owner's Name �` ------------ Phone------------------------------------ Address --------------------------------------------------................................... Contractor's Name-----------•---J4 �r `~ ,,,� ---------------------------------------------------------- Phone................................... Installation will serve: ResidencewET--Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ Number of living units: ----L Number of bedrooms .,3.-- Number of baths J---- Lot size __..�"�.._��./Q....................... Water Supply: Public system P'111�c_ommunity system ❑ Private ❑ Depth To Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No UK-New Construction: Yes ®--f Vo ❑ FHA/VA: Yes ❑ Noe - 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-----------------Distance from foundation-_,/_d........-..Mate alb----4t'_ _ !.� ................ [f� No. of compartments------__2 ----------Size...._(-___. -y�, -Liquid depth__.__lil/Z_.._.------Capacity.._. -------- Disposa geld: Distance from nearest well. ___-_.'_._--Distance from foundation__,1.6 istance to nearest lot line__ ___..... f 9 Number of lines_____________ �-._Length of each line-_.__.__._-_ __ �___ __-.Width of trench.__�__` .:_'.....______._____ ------ Type of filter material._._=_!2- Ya4_�rbepth of filter material.. -----------Total length___1j"L2'.....I----------------- See pag It: Distance to nearest well----------------------Distance from foundation_._f_ __�.____.Distance to nearest lot line_'r�...._. Number of pits_.__(XZ]�__Lining material_1�a. .l�__..Size: Diameter. y.-.__Dept h----- S'�________________ Cesspool: Distance from nearEsf-,ell-----------------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-----------------------------------------------------•------•-•------ Remodeling and/or repairing (describe=-------------------- -- - --•- -- -------------__-__---..__._.. __.• .,, ....--------.................. ------------•-•----•------------------ •---•----------------- -----------------------•- ---------------------------------••--------------•-------•----------------- --------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws nd rules an egulations of the San Joaquin Local Health District. (Signed) ------> ------------------------------------(Owner and/or Contractor) !/� rtlel -------------- ------ By: ---•---•••--------------------------Ion (Plot plan, showing size of lot. Iof system in relation to wells, buildings, etc;-t3n be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--- DATE_________ ___ ____-( _. _ ------------- -- ------- REVIEWED BY • - -------------------------------------------------------- SIJED --------•-••-------------------•- DATE-------•-----••------._-..-•-----------------•----••--•- BUILDINGPERMIT IS -------------------------------------------•-------------------------•--------------- DATE----------------------------------------------------- Alterations and/or recommendations:.---9-_-_G- - ci --- -`. __ . `.. c� b.Ga _. Z- ----------- ------------------T FINAL INSPECTION BY:. -- - -- ------ -- - ---------------------- Date . '-b - SAN JOAQUIN LOCAL HEALTH DISTRICT 139 South American Street 300 Wert Oak Street 124 Sycamore Stmt 205 Wort 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 9.62 ATLAS