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Fv rig _. NO PO4K, COPY M Ti RJP` APPLICATION FOR SANITATION PERMIT � .Ct' Permit No. - :'. ---------------------------- -------------- (Complete in Duplicate)- --- This Permit Ex fres i Year From Date, Issued Date Issued -_,� Y Application is hereby made to the San Joaquin Local Health District fore permit to construct and install the work herein described. This application is made in compliance with Countyrdinance No. 549. ' R JOB ADDRESS AND LOC N. - L -- ...............:.A..-- Owner's Name------------ .. _ _ _ .r Y............................................................... "�� - ------•-------•------------------------• •- .-=-Phone--------------------•------ �' Address -------- ------------ ------ /rte- -- -------•----.:---------••---•-•- --•-- F. Phone...P�.: Installation will serve. Residence � Apartment - _-_--•-------------•-•--_•• • Contractor's Name---- .. ................ use ❑ Commercial ❑ Trailer Court ❑ .Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms - Number,of baths __.�..-"' Lot size ... y� t Water Supply. Public system ❑ Community system ❑ .Private /[�epth to Wafter Table _ ft. Character of soil to a depth of 3 feet: Sand 12 Gravel ❑ ; Say Loom ❑ Gay Loam ❑ Clay [] Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date.-"'"`-'--..- -,} No <= New Construction: Yes No ❑ FHA/VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: r '4 �,'"`� x (No septic tank or cesspool permitted if public sewer is available-within 200 f4t.)- Se Tank: Distance from nearest well__--_Z5:Dis#ant r m oundation_---.!__ _-..--.Materi L_---_ p " 2 ----------Size..,-' ____ ' Liquid depth_. �a ;�---Capacity. . Dis s l Field: Distance from nearest w P No. o tom ar mems--------Well_ Distance from foundation___ . -.____•Distance t5 nearest to Number of lines.--i__--_ t line-. Q yA I . ----- Length of,each line_-_----_1-..---__.:_-----.Width of trench. ------- µ-._-Depth of filter material-.--e _--------Total length.------- -- --- ------ Seepage Pit: Distance to nearest well e o filter material._ 1 i -___Distance from foundation....................Distance to nearest lot line-_----__---__--._ ❑ Number of pits-__1 material--" = r' -------Size: Diameter------- y -Depth Cesspool- %Distance.from nearest well--- -----------Distance from foundation...;.--__-_J- ---..Lining material__.---:.--..---_-- ._.� ❑ Size: 13iameter ---------- -----------•-----••--Depth-----------,�-------------I =------- "` j Priv I Liquid Capacity- -••---••----------••---gals. Privy: Distance from nearest Well---------------------_-_------------�--.- --Distance from nearest building------------------------------------------- Cl Distance to nearest lot line-------------•_---_•-- Remodeling and/or repairing {describe}:-------I- --------- I - f I-•-----•- --- --•••--- •---------- ; • - _ -- _- - t_n-------------------------------------------------- - JIf I hereby certify that I have prepared +his application and that the work will be done in accord ----------- - -------------------------------------- ordinances, - - -------------- ordinances, State law , and rules and re lotions of the San Joaquin Lacal Health District, ante with San Joaquin County I r. ;r (Signed) f� _ ,..... .., �O_ i - • - - - i---------------------------- --- ---------• ="-- __. r r Contractor) --�•- -- Wile an O - -------------------------------------------{Title)>- ------------------------------- ( P g y - """ Plot Ian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ., REVIEWED BY------------------------------------ i- .. --�' DATE--------�` -------- -------- APPLICATION ACCEPTED BUILDING PERMIT ISSUED-- _--------- � ------------------------------------------------------ ---- DATE -------- ------- -•-- Alterations and/or recommendations:---+------•--- . – ... DATE ..r FINAL INSPECTI Date--------- e'-a—Z-7 --------------------••---- l j SAN JOAQUIN LOCAL HEALTH DISTRICT 130 south American Street 300 West Oak Street Syeamore Street Stockton,California05 West 9th Street CaliforniaLodi,,California 124 Manteca,California Tracy,California E$ 9 RE VI5 ED e•59 sM 9-61 ATLAS' =�'