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VNNi Ag- �- — �. --------------------- ------------- � _Z__t�__---- APPLICATION FOR SANITATION PERMIT Permit No. . ----------------- -•------- ----------------------------- (Complete in Duplicate) ----- ------------- ----- This-Permit Expires 1 Year From Date issued Date Issued --____l.f�lS�.• 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 LO TION_ /vZ � TMJ---• -------- Owner' Name------- 47 .�:.- .. -.• - ------------------------ -------------------------------------- Phone.............•-• Address---------•---•--.. - ------- Contractor's Name Phone ----------------------------------------------------- Installation will serve: Residence 2- Apartment House ❑ Commercial ❑ Trailer Court ❑/ Motel [) Other ❑ Number of living units: A__- Number of bedrooms- __ Number of baths -2— _ Lot size Water Supply: Public system ®-.-C'ommunity system ❑ Private ❑ Depth ro Water Table W"a ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g1--gardpan 0 Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ` Distance from nearest well_________________Distance from . - foundation______. ______-_._.Material_____-._____.__________._____._______...___...__.No. of compartments-------------- ........... depth-------------------------- Capacity `da Distance from nearest well--_[_____________Distance from foundation-----.--------------Distance to nearest lot line-_____...-._----- Disposal`F Number of lines____________ _ - - ------•------------Length of each line--------------------•-------..Width of-trench P rial-----------------------Total le'an-gth------------------_------- Pit.a e Pjt: Dis#ante to nearest we1L__________ _________Distance"fr fo nd Type o iter material_______________ ___.___ Depth of filter mate g ation_�p_�......Distance to nearest line_�_�_.__. Number of pits___-. -_---k----Lining material__4-i°� '-�_-Size: Diameter_3Zpr--------Depth o�__�!_---_-----_- ', l esspoo : Distance from nearest well-----------------Distance from foundation-------------------_Lining material------------------------------------- El Size: y Liquid Capacity ----------------gals. ----- Priv Distance from nearest well -________Depth--A- _,-------------------Distance from nearest building.-_-_..___-________•----__•__-------- ❑ Distance to nearest lot line--------- --•-------- -•- --- --- ------------------•-•----___-•- Remodeling and/or repairing (descri€�e):___._________._____ ------•------------------••------••----•----------------•--•-•-1 .......----- ------------------------------ ----••--------••------ --- •---------------•----------------------------------------------------•------------•-------------•-•-----••---•------•------------•------------------- I herebycertify that I h y have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lWands and re ulations of the San Joaquin Local Health District. (Signed)_ - -------------------- ----(� By:-------------------------------------------•--• �_"* Title... Contractor) I (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --- ----��/" "-- DATEs 1' 6 - ---------- REVIEWED BY_.. ------ ------------ DATE-------------------- -------PERMIT IS - ••----_-- ---------------------------------------- Alterations, - -------------- --------------- DATE _ AFFeratio d or re mmendations•----•. '`�` �-��- s� L - -... i `_ r'----- - . ._ ------------•-------------- •------------.-... FINAL INSPECTION BY:--`"__:/t._- �— r`� 3 - --------------•-------- ------------------ Date- •------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amorfcan Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Locif,California Manteca,California Tracy,California t ES 4 REVISED 8-59 2M 5-62 ATLAS