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FOR OFFI�E USE: "= Ar-4441 --------------- -- -- -----�.,:_3L'__.____ 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, JOB ADDRESS AND LOCATION ----------------------------------------------------------------------- Owner's Name----------. ---- ----------- ---------------------- ----------------------.. Phone-1h2 ------ Address....... �� l 1 n ---------- ----------------� �------------ ---•--------------------------•----------------------•-------•• ymContractor's Nam �\7 --- "'` �h D Phone... �.........'7.. Installation will serve: Residence ❑ Apartment House ❑ om rciial ❑ Fa`ler Court ❑ Motel ❑ Other 1 �� i Number of living units: -------- Nu ber of bedrooms ______- Number of baths .------- Lot size ______ —........................... Water'Supply: Public system Community system ❑ Private ❑ Depth TO Water Table _60ft. ' Character'of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loamy [3Adobe Hardpan 11 { Previous Application Made: (If yes,date--------------- --) No E] New Construction: Yes � NCo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet.) ``�� r Septic T : Distance from nearest well-fln-0-- from foundation---1p..........Material-_____ [ No. of compartments_.`.�i____.__..__.__._.._Size______________ 6___oLra_ __Liquid depth__.._r�.�'-_________Capacity-_.•-.). ?11�14, Disposal F Distance from nearest well.--q—.Distance from foundation___1 __._.._Distance to nearest lot line.....Z-2 R � 0Number of lines_____. __.. ._�_____________Length of each line______.............Width of trench____ 1..`....___.__._.._._ Type of filter materials- f-__Depth of filter material-----/. .'".._.__Tatal length------- ...................:. �} Seepage ' . Distance to nearest well_N29�: -_ Distanc rom founa6tion__.../. F/__.Distance to nearest lot line----- Number of pits____-___�__i-______Lining material_ m_-k-------Size: Diameter-----Z :.._ f-Depth_-._- !______________ Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining -------------------------------------- El Size: Diameter________________'---------------ro _____.De th--.__-.------.._ I +---Liquid Capacity gals. ' Privy: Distance from nearest well---------------___�__'�_ ` •-- "---Distance from nearest building ❑ Distance to nearest lot line_____________ -----------------------------------------•--••--•- Remodeling sand/or repairing (describer --- .....1._....---•---............................................ _. :- .--------------- = ------ - } riiL. -----------------------------•-----------------------•-------•------- •--`--------------------------------------------------------------- --------------------------------------------------------------- hereby certify that I have prepared this application and that the work will-6e done in accordance with San Joaquin County ordinances�Iaws nd rules and regulations of the San Joaquin Local Health-District. l" ~r (Signed} �- - 'L 0- C t ----------•--- .{ Contractor) By:-_-----•-----•---------- I --------------I ifle)------------- It------- ----•--- --------------- - ------- (Plot plan;showing size of lot, location of system it rel io to`wells, buildin „etc., can-6e placed on reverse side}. , FOR EPARTMENT USE ONLY APPLICATIQN ACCEPTED BY---Xl__*---- - ---CZti`'L ----------------------------------------------•---- DATE---,-/-.-- ----••------------- REVIEWEDBY----------------------------------------------- -------------------------------------------------- DATE-------------------•-----•-----...... BUILDING PERMIT ISSUED----- -----------------:;- %:--------------------%-------------------------------------------------- DATE---- --- Alterations and/or recommen�tions:------f -- ------------- 1—�� '= ------- ----------------- -------------------------------------- --------------------------- ---- --------------•- ------- --- -------------------------------- -------- ------------------------------------------------------------------- FINAL INSPECTION BY:.. 2411, Gt i✓ — Date------------------------------------- -••-------------------------------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 Wool Oak Street 144 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS