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�K I UFC . ,1 F ......................--.----11,x---.---- .---___.--� "No. .APPLICATION FOR SANITATION PERMIT Permit No. ............... .. Com lefe in Du hcate ---------� --.- --- This Permit Ex fres 1 Year From Date Issued Date Issued __--112W 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......-�--�-/------------- __ _ —"' r --- r -------- ---- .--•--` -•----s�-- / oz14adl y Owner's Name...-•-------- --/11'�:--------Y�1.LV..G/��[..------------------------ --- ----- - --•--- Phone---------------------------------.. -----------------------------------------Address.---------------....... -un t - Ol lhoneContractor's Name------------------ ✓ I-•-- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .---- Number of bedrooms _ .. Number of baths _-/.. Lot size . _ �.................... Water Supply: Public system 2--60mmunity system ❑ Private ❑ Depth .ro Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [3 Clay ❑ Adobe❑ Hardpan [] Previous Application Made: (If yes,date--------------------) No New Construction: Yes FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: `� + (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-__-- � Distance from foundation-_f�---_-..--Material--- -��...-r- . fi No.,of compartments--_--- --------------Size--_--_3X--- Liquid depth__-_�________._-.?Capacity__----ec�0-_-.-_ --- ------- Disposal Field: Distance from nearest well --_-� .-Distance from foundation----la----:...-.Distance fie nearest lot Iine�T�__..._...- (?� Number of lines______ ________ ________________LeEA of �at�'ICine_ r.Width of trench .--�� ..-...._________.___ Type of filter material.-.- O jy^------Depth of filter material-----l. "......Total length.-.lS�-------------- Seepage Pit: Distance to nearest well-_-_.----------Distance from foundation....Jll_--I......Distance to nearest lot line'6......._---. I Number of its----.- --- "� p �-----------Lining material Diameter----�,�---------Depfih---_�,�------------------ Cesspool: Distance from nearest well-----------=-=--Distance from foundation.----.--------------Lining material-----------------------------------__ V ❑ Size: Diameter-------•------------------- --_.:Depth-------------- ------------------------------------Liquid Capacity gets. Privy: Distance from nearest well---------------------------------------------------Distance from nearest building.----:-----.•--•---_.-------------------.. —� y ❑ Distance to nearest lot line ----=--- ----------------- -=------------------------------------------••---••--------------•---•---•----•-•-------------------- ti Remodeling and/or repairing (describe):--__..-.-.--- +C.�+ -------------------------- / -----------•-----------------••---•---•------------------•- -- I hereby cerfif that I have prepared this application YI^. -- -- •----- --------------------------------------••--_- •----_--•--__--- ---- -------....------------------------------•-----...---'---......---_...------------•---------------------- and that the work will be done in accordance with San Joaquin Caun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------------------------------------- -------- ---- ---------------------------------------- - -----------------------(Owner and/or Contractor . gY� ------------------------ -------------------•• ---------------------(riifle)-------------------------------- -------------.---------------- (Plot plan owing size of lot, location of,system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY " ----------------------------------- • DATE �`�..� . -- 3 REVIEWEDBY--------------------------------------- ------------------------------ -----•---------------------------------------- DATE--------------------...------------------------------------- BUILDING PERMIT ISSUED--_----_------------------ ----------------------__------------------------------- DATE...----------------- 3 Alterations and/or recommendations:-------- y , ori ----- ----------------------------------------- ------ -------------------------------------------------------------------------------------------------------------------------------------- .-.-..--------------_•--------- FINAL INSPECTION BY:---- - ...-- •----------- -------------- Date.-..---=� 1 4 - --------' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stroh 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS