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rvtc,vrmi - U5E: ------ -------------------------------------------------- j APPLICATION FOR SANITATION PERMIT . - 5. Permit No. .... .---. --------------------- -- t -(Complete in Duplicate)—f --, -{ , j . — This Permit Ex lres`t Year From.Date Issued Date Issued Application is hereby made to the.:S�n�Joaqui 1 E6—cal-F6alfh District for a permit to construct and install the work herein described.: . This application is made in complia`rice with County Ordinance N�•549. i f `-. ; L JOB ADDRESS AND LO AT10N.: _ r . Owner's Name_. == _t - f � r,. -----'^ P Address.................. Contractor's Name___ - - ' Installation will serve: Residence Apartment House Commercial.❑6 Tral er Court ❑ 'Motel • . ,t ❑ -Other ❑ Number of living units: .._ __- Number of bedrooms -_, Number of baths _ Lot size ` Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table A5�O ft. Character of soil to a depth of 3 feet: Sand [I Gravel ❑ any Loam Gl Sandy kClay Loam I � Y K Clay ❑ Adobe❑ Hardpan [] Previous Application Made: Of yes date.__.______----- f No ❑ New Construction: Yesx No .a ❑ FNA/VA: Yes ❑ No ❑ ; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool-peermitted if public.sqger is available within 200 feet.) Septic Tank: Distance from nearest well--,519_ y 1` Distance from fdti�lP prn � ___ __-,...•_.Mafierial No. of compartments------------._------Size --- ZL'llquid depth--------_ --- - - ---Capacity-19.&, p- Disposal Field: Distance from nearest:wel!-__5Q------Distance from foundation...1Q -...Distance to nearest lot lin ..]---__-___,- Number of lines___ r1 - ,�,�g p Length of each fine___- .___ Width of trench.--.3 .- 1' Type of filter material...!_� - Depth of filter material__�_ ----_ Total length------ ------- ...__ PIS) p Seepage Pit: Distance to nearest well -- __------__-Distance frorrFf u dation.-�t?_.•�___.Dist nce to nearest lot linp-47 f ,a Number of pits__-__-----.l.-- Lining materia ...... - 5ize: Diameter_::T-��-------.Depth_-�d�..-------.---•--- Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material__.--___.-..___--______...__ Size: Diameter----- -•---•-------------------------Depth---------------------- --------------------------- Liquid- Capacity----------------------------gals. Privy: Distance from nearest well_____________________________ -------------------------------------------------Distance from nearest building----------------- Distance to nearest lot line____--________-_______ _- -------------- g ------ Remodeling and/or repairing (describe)_______ __ -. ---•----------------------------- `" I here6� certif that I have p PP Y y prepared this-'application and }hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations the San Joaquin Local Health District. [Signed].. ---------- ---- ---=:... - _._,._ and/or Contractor) _- net d/o C tar) ---------------------- -- - •--_- ------ — ___—: _=(-Title)-.- -- == - (Plot plan, showing size of lot. Iota n o sys em in relation to wells, buildings, etc., can be placed n reverse side). FOR DEPARTMENT USE ONLY AePLICATION ACCEPTED BY.__�l K .0-'--- ----------------------------------------------------------------- DATE---- _` _ _ ! ------------------------- ---------------------- -- --------------- REVIEWED BY --- - -----. DATE.....:.... :...••- ---_. BUILDING PERMIT ISSUED------------------# Alterettons an /or recommendations:.-`=---•------------------------------------------ • -------- --- -------- -- ---- - ---•- HA:/-'(Cr�=� ��.c�15� �� .I----------------------- 411e _l'r9� � -- = -- -- --- -- [ 1 + �1 _!_' -__. i4LLG-1 ------- �� 110 �... _.�I... L�t/fE. .. :_. ----•-•------�i�=..�_f_ .1-------___--9._ U -- -- - —�— a- 61 - ----- -- - ------- f `- FINAL INSPECTION BY:, _1 � '✓�''/ Date. U...� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street '"�724 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS