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FOR OFFICE USE: /E: 1, Permit No. ...._ .._..(.._.... � ------------- `y�-----"------ --�---"�--- --- -- ---�" APPLICATION FOR SANITATION FERMI T'----------------------- ----------------------------- (Complete in Duplicate) Date , ------------------------------------- --."--- This Permit Expires 1 Year From Date Issued t 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. } fe I JOB ADDRESS AN OCATION------_c.- rl Phone---------•------• Owner's Name------ • -------- �: --•------- Address------.... � 3...__ - �------------ --------•-•------- ,. -- ------- - - -- - -- Contractor's Name------------ y Installation will serve: Residence Apartment House ❑ Commercial [3 Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: ..... Number of bedrooms,.- Number of baths -------- Lot sl ze ...V.5----- . •• - Water Supply: Public system� Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel C3 Sandy Loam❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ FHA/VA: Yes E] No Previous Application Made: (if yes,date_------------------_) No � New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Distance f m foun ation___ _� � • Septic Tank: Distance from neare f well' LP' .._ .� C-- aci .••--•• No. of compartment s_-------iA-----------Size------ jt ---------Llquid"dept--•----------- Disposal � l Field: Distance from nearest well_ oz+L�Distance from foundation__-_,�D----:.---Distance to nearest lot I;_e_,��....__.... :.� i Width of trench__.a �ih----•----•••--------- Number of lines..--------- _:I "-- ----•--Length of each line__.___� ._ -"_--- De Depth of filter material____. g- rte.---Total length---- Type of filter materials. - p Distance to nearest well----2z4-?��-- Distance from f undation_-.-.,�. ....`..Di Lance to nearest lotJine... -.----- 1 Seepage - - Number of pits__._.-----------Lining material-- Size: Diameter _ ..-•--------.._,Depth.._�r----•-. fir Cesspool: Distance from nearest well____._L___:_--.Distance from foundation--------------------Lining material---............................. FIs. l De th I----------!..Liquid Capacity---------------------------g ❑ Size: Diameter-----------------------------.-----t---I . P t- , I --------------- -------_Distance from nearest building--------------------------_1---•--.----- Privy: Distance from nearest well_______ ________________ ( , ❑ -------- ------•-- ------------- Distance to nearest lot Line._"----------------•------------= -•---- I Remod ling and/or repairing (describe]:-----6Z ~ - --•------- --•rte--�xxs-t'.�: 4i r , ( 1-F-ereby certify that I have prepared this application-and',that the work will be done in_ accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I --_--I---_____..___--____-(Owner and/or Contractor) _ _ (Signed} .� T"tle} ----•-------------------------- ---- -- (Plot plan, &&'win site of lot, location of system in relation to wells, buildings, etc., can be placedon reverse side). FOR DEPARTM T USE ONLY APPLICATION ACCEPTED BY-------- --- ---------•----'- ---------- DATE_..... ..:.1...4._' ---------------------------- DATE-------••----------------------------•-- -------- REVIEWED BY_.. i r7 rBUILDING PERMIT ISSUED------------------ --- Alterations and/or recommendatio _ --:- . �l _. `/ J St /� -[--�- 4� ............. ..'__ .---- ---•!_' fA �..__._..----: ---------- -- ----'---- :_7� '-•---- '• - y �f. f <4 .. 7 Da#e- •-----------------•--•------ ....... FINAL INSPECTION BY------------------"---•- - -- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Sireef 124 Sycamore Street 205 West 91h street 130 South American Slnef TracCalifornia 5tockton,California Lodi,California Manteca,California y� ES 9 REVISED 8.59 pM 5-61 ATLAS t