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R OFFICE USE: FO ------ ----- --- IM. APPLICATION FOR SANITATION PERMIT Permit No. ._.��..�/� Z -- -------------�-�- �� - ---------- --------------------- ------------- - __-- ------------- - (Complete in Duplicate} r 7. 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 Ordinance No. 549. .�I JOB ADDRESS AND LOCATION-__ 9 a_/ �6 - 51j 7Z�F_!✓.-%--_ ? t' • - --------_ -------- -- cr ----------------------------------------------------------•---------------•----•-- Owner's Name -- � el ��4� ..... — ---------------- ....::........... Contractors Name = •------------•------------------------------•••---..-..--•-•••-•-..... Address.----•---------•--_----- ` Installation will serve: Reside / '1-L�-...Y..f..--•• f�1z ---- ----- ------------------------ Phone• ' =� G o Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ($' C11-61FU ' Number of iia�untts:�- ----- Number of bedrooms -------- Number of baths -------- Lot size r Water Supply: Public systemlI`'❑ Community system ❑- Private ❑ Depth to Wate.r Table ........ ft. �� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam [3 Clay E] Adobe Hardpan E] Previous Application Made: ilf yes,date----------------__) No;�T, New Construction: Yes JD No ❑ FHA/VA: Yes [] No , TYPE OF INSTALLATION AND SPECIFICATIONS: l . _(N_q�septictic tank rsspool permitted if pubic sewer is available within 200 feet.) �Distancerom nearest well9ncerom foundation. Material �'- 2 � AWtNo. of corn artments------------_2_----.----size..... __Liquid de th------------- -----Capacity...... k . D a field: stance from nearest well.. // �--Distance from foundation-------f4 f- Distance to nearest lot line.....:...... �„/G umber of lines----_-._.._-_.__/__-_-_.___.-Length of each line------- Q--------.Width of french f_---------- --------------- "�� Type of filter material, -.Depth of_filter material--- '-----_.-Total lengt ...... ____________________ Number o .,�.., . le Seep a Pit: Distance to nearest well__X0,.�,c __Distance from,f ndation--____� _____-_.Distance to nearest lot line-_---- --f P Size: Diameter-........ Depth 4-5- �. ' pits----------/---------Lining material__---- 3 p . Gesspo Distance from nearest well-------=---------Distance from foundation.------------ Lining,material::--------.-------- -''•._:_.-_..-_____ ❑ ; *Size:,Diameter------------------------- i--------.De th-------------------------------------------------= Liquid Capacity . gals. Privy: 'Distance from nearest well:'-----------------------------t�.;----------:. m nearest building-----------------------------------`:-.... ` I f Distance from Remodeling and/or re airin describe : line----------------•----------------- - - --- ---..------------------------•---•----•-••---••----.....------------------ ' ❑ € Distance to nearest of t I l �� Z�lx f . / P. 9 ) ) �-------- -- -----` � -- --- ....... r�----•---- i •' � _ - -------------=----------- ----------------------------------- --------- I ereby certify that I Wye prtapared this,,ap licafiori.and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and_4—g'ui lations of the Sait Joaquin_Local Health District. �- (Signed).. i ned i = --#--'- -{Owner and/or Contractor) BY� --------------------------'m- --------------------------------------------------------------------- -----------------------(Title)-------------------•--------•-------------- -- ---------- ------ (Plot plan, Showing size of lot,l ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPA!j ATT USE ONLY_ APPLICATION ACCEPTED BY ------f -------- --------------- DATE-------- ------=------ REVIEWEDBY---- ......_-------------�--•--•---• --------- ----------------------------- ....................... DATE---------------------------------------- BUILDING PERMIT ISSUED---l1 ------ ------- ---------------------- --------------------------------------------- DATE-------•------•-----_--_w--------------------------------- Alterations and/or recor,ttm d5tions:--_- -.---. - _ T, -P --••-•- 1 �---------- '"I`_�` c,_LfL.-i r-e `�`" �. -� .............................. ----------------- ------------------------------ y z -c. _'-•......----ta' T/L:Z------�(-'C"'�'------- -•-- ----- ........ ' FINAL INSPECTION BY:---'��--� i ----------------••- ----------•- C Date---- - • -•- ' ' SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Strut a Stockton,California Lodi,California Manteca,Callfornia Tracy,California ES•9 kEVISEP 6.59 2M 5-61 ATLAS