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FOR O...4:i,4` F !/ .. d ------- ---- -------- ----------------- ,f APPLICATION FOR SANITATION PERMIT Permit No. ..;1�,�.. -------------- ------------------------------------------ (Complete in Duplicate) ---- -------------- - This Permit Expires 1 Year From Date Issued 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 Or No. 549. JOB ADDRESS AND r-LOCATION.... Owner's Name------------.<-;VA-44------------- -------•-- - ---------= - PhoneH ...A-A.Z6 Address _ EleJT / __ .... fix -------------•---•---- _..._.... ----------•--•-------•-----•----------------- Contractor's Name ------------------------------- ---•---. Phone................................... Installation will serve: Residence" `Apartment,Ho e ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ .__ Number of bedrooms -a'-_ Number of baths a�..__ Lot size `�a'ar.?� -----,�-?� - a� �D✓. Water Supply: Public system ;9, Community system Ef Private CI- -Depth to WaterTable ......... ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑. Sandy Loam ❑ Clay Loam ❑-_Clay ❑ Adobe(�' Hardpan I] Previous Application Made: (If yes,date____________________) No New Construction: Yes ElNo; FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ink: Distance from nearest well____________ _pistance from foundation_-__.._____--..___.Material.._______._______-.._ No. of compartments e---------------------------1--Liquid depth Capacity -----•-----•--...---•-- DisposaJ.field: Distance .from nearest well_47%*-re--Distance from foundation...1i9----------Distance to nearest lot line____ ..... Number of lines...... --Length of each line----------- 0-'-----_.Width of trench---..a1_ _ •-•------_--• Type of filter materia' Depth of filter material-------,l_ _- Total length______________ .-•___-__-•-_-____-• Seepage Pit: Distance to nearest well__ rC.r__Distance from — foundti nA- .�- e- D ..ze: to nearest lot line____,. Number of pits ,L_______-_-__Liningmateri�aeZ_4s -----0o � , ---------------- Cesspool:: Dante from nearest well-_______________Distance from foundation__._________#.._ Lining material.___.__.__ ____-.___.____.❑ ze: Diameter.-------- `--------- ----Liquid Capacity............................gals. Privy: Distance I from nearest well_________________________________________.-_____Distance from nearest building--________.________-._.__..._. ❑ Distance to nearest lot line---------- --- l A � Iw,� Remodeling an�repairinq describeJ: _ Z T � `�' _ qq // ----------------------___----------_------------------_____..--------.-----------------------------------------..-_____________:_____-__.._______-__--__________-._______•_-._____.._.....•.-.____-_____...__.._.___._-__.____ hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r ation of the San Joaquin Local Health District. \ ! ---- (Signed)- r/ -- ----- -------------- ------------------- --------------------- ------------------------------------------(Owner and/or Contractor By:........................................... -------- -------------------------------------------------- --•-- --------(Title)--...------------------------------------ ................. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTME T-USE ONLY APPLICATION ACCEPTED B ----- - --------- ---------- -------•----------- DATE------.� CO I REVIEWED BY ------------ ------------------- DATE. BUILDING PERMIT ISSUED---------------- -----------------------•---_------------------;•----------------------------------- DATE. tions and/or recommendations: _ I ' -------- ----------- t57 -------•------ --:-•------•----•-----•-•-----•-••---------- ----•-------....._--.- ----------=-------------- ..... •-- ........_ ._. ._._ ® �� _____-__ y Z.-( . ---- �.--r� ------- j ,cGn� ----------------------------------------- FINAL INSPECTION BY. :_. --:�. L L Date..... --71- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wert 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 @M 8-51 ATLAS