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FOR OFFICE USE: ------------ APPLICATION FOR SANITATION PERMIT Permit No. ------ -------2.�-------------- --- -- ------------------------------------------------------- '-(Complete in Duplicate] a 3v ------------------------------------------ ----- --- This Permit Expires 1 Year From Date Issued Date Issued ------- Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. I U�i �LOCATION. 0f 6' til JOB ADDRESS AND ----1------C---R--------- ----------------- ...........),L-A rH Ro P --------------------------------------------------- Owner's Name---------- ------------------------------- ----------------------------------------- --- Phone------------------------------------ #Z Address-.-.---------*N.M. ...... ---------13.0 FJ-Z.. 4, 12 --------............ ----------------------------------------- __P----------------- Contractor's Name------- ------------------------- .................. _------------_---------- Installation will serve: Residence f�r--Apartment Nfle ❑ Commercial E] Trailer Court El ?.Motel [3 Other E] Number of living units:../,.--- Number of bedrooms .-2- Number of baths /._ Lot size .......................... Water Supply: Public system �Community k syg,erh,E] Private [:] Depth TO Water Table -----��_ft. Character of soil to a depth of 3 feet: Sand e&rave't,0 Sandy Loam WlClay Loam [] Clay 0 Adobe[:] Hardpan [I Previous Application Made: (If yes,date--------------------) No 0* New Construction: Yes E] No ❑ FHA/VA..Yes F1 No E] TYPE OF INSTALLATION AND SPECIFICATIONS A (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se nk: Distance from nearest well_)W./V_F-D1stanc'@ 4rorn', founclation'-1_.0___._ 6.tpjj-aI__/? ----------- P ....C9pacity_. pe No. of compartments..-------.7—---------Size...139eV.1K.5 Liquid dep'th..... ....... VZ Disposal Field. Distance from nearest wel1A/!0N_C:Distance I ,and alf i o n _.Distance to nearest lot line--- --------- RnV---ZV__ `_--.Width ofjrencOl--- 41 , �4 Number of lines....-----_f --------Length of d -------------------- Iter material------ p------- --a0____________________ Seepage of filter material._ -.---Depth of filter ----I----Total Iting -------- Seepage Pit: Distance to nearest well---VVJV__e=Distance from foundation......ZO_.J�.16i�tanc`6 to. nearest line...-.5....___._ 1 Number of �aterial__�(7�.�._.Size: Diarri;teA:A._X140__r. "Depth----1.-�9. .......... Cesspool: Distance from I ILar%th;e ----------Distance from founcaf ion - -----------------Liningjmafe'rial,01 --- ---------__._........ ESize: Diameter- jDepth Liquid LCaals.p . - --- Privy: Distance from Aearesf well_-_-_-_____-_--_______----___--------- -----Distance from �iearesf buildinq------------- ------------------------------ .......... .. F1 Distance to ne),res+ lot line---11 ---------------------- ------------------ ........................ -------------;------ 4 Remodeling and/or repairing (describe):____-_ -------- ---- --- --- 1 -- ----------I------- -- ----- - - - - - - - - - - -------------------------------------------------------------------------------------------------------------------------------------- ----- -------------- ------- -------------------- ----------- _�7_T----------------- _=4V--------------- vc� J ------------ -------------------------------------------------------------------------------------------------------------------------------------------------------- � --------------- NO-F-tc-4;---- ------- I hereby certify that I have prepared this application and that the work will be done in accordance iiiith SanJoaquin County",.! ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. R 0 (Signed)--------------- ------------------------------------- --------------------------------------------(Owner and/or Contractor) ...eA --------:--------------------------Title ----------------------r----------- By:_ --------------I (r ------- ------------ '(Plot plan, owing size of lot, location o system in relation Polo ]On o to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIOWACCEPTED -BY -----------------=-•------------------------------------------- YATE......./49------------------ ----------- REVIE�VEb "By..-----------------I-------- --------- D ------------------------------------------------------------------------------ DATE---::..... ............................ -k V - BUILDING PERMIT ISSUED._...........................z "Vk\--------- -- - -- -\A ------ ---------------- ATE!........................... -------__------------------ AlFeretio ns and/or recommendations:-----------------------------------------------------------------------------------------------------•-----...----------------------------------------------- -------- - I?B_--- --nk ------f------------------------------------------------------------------------------------------------- ---------- _175----11 ---------------------------------------------------------------------------------------------------------*-------------------------------------- ------------------------------------------------------------- ------------------- ---------- --- -- ----- ----------------------------------------------------- ----------------------------------------------------- --------------------------------------------------------- - ------------------ ---------- ----------------- FINAL IiP ION BY-------- ------------ --------- ---- ---------------------- Date-------------------- ------------ SAN JOAQUiN LOCAL HEALTH DISTRICT .1.30 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Sf0Ck1Qnr California Lodi,California Manteca,California Tracy'California ES 9"REVISiED B.59 2M 5-62 ATLAS sw,