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FOR OFFICE U •3a4 ' ' f 1/ ----- ----- Permit No. .1.�� .. ` - - -- -- ----- -- __ ---- APPLICATION FOR SANITATION PERMIT - __, __ i_ -':�'_'� •.- _____--. (Complete in Duplicate) 6 ------------------------------ - This Permit Expires 1 Year From Date Issued Date Issued ___ . ___la Application is hereby made to the San Joaquin Local Health District for a per it to construct and install the work herein described. This application is made in ompliance with County�rdina a No. 549. 10 `*'� J08 ADDRESS AND L T ; --- ---------='-------------••••-•-•--._....._..----------•-•---••-•----•-•-••-••---.....------- Owner's Name------- tis .,,,,------ -- -- --------------------------------------------- --------------------- Address ------------------- PhoneA..`> �` Address------------•---`-... � --•------------------•-------- Contractor's Name..__ z�- 'r1lu_- 1L. � �' � phonef-U _�a 'sQ�"" I IV i Installation will serve: Residence CKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑� Number of living units: J_____ Number of bedrooms -2--- Number of baths --r____ Lot size ...7_i!1__ ---/- ........................... Water Supply: Public system Community system ❑ Private ❑ Depth TO Water Table ._6pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[,Hardpan ❑ Previous Application Made: [if yes,date--------------------I No ❑ New Construction: Yes ❑ No U3"'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) fi?PtiG Distance from ndatest well•______-__Distance from foundation__-_.__.._________.Material---------------___-------------------------------- jj tb�lNo. of compartments------------------------ -Size--------------------------------Liquid depth--------------------------Capacity----------------------- ! pos el Distance. from freaTest we > Distance from foundation....-�_._. Distance to nearest lot line...__6_ ... L ~�, ' Wi Number oflines______-- ------ ----Length of each line__ Q-.---_--••---- dth of trench._. _ ' ---------------- .� i Type ofifilter materialsto,- c:-R4-_Depth of filter material____ _____..___Total length____ 1.Q____________________________Seepa ePit: Distance to neares#'weftJ-�-______Distance from foundation___..!_____________Distance to nearest lot G�e.�_____..- � Nurnbrer of pits----f----------- ---Lining material--'- •c?-c�C----Size: Diameter- �.�__.Depth-_-- ------------------ '�,) Cesspool: Distance from nearest well_________________Distance from foundation.-------------------Lining material__ ________-_-.--_________________ ❑ __Li Liquid Capacity { als. + Size:'.Diameter------ - -�-------I------- - --------Depth_--•---•-----------•------------•-------- - ------ q ------....-------._.._.--•9 I Privy: Distance from nearest well_______________________----_-------------- -----Distance from nearest building-____.-_...._______.._._.________--- ❑ Distance to nearest lot line--------------------------'-- ---------------------------------------------•--------------------- •---------•------------------------------- Remodeling and/or repairing (describe):-------------- - --.-----------_.. ----------------------,. -- ----•-•-----v -------------------- -- --•--••-- ••--- --- P --- - ---- ---•------------- ---- •- -- _____ __ 1 --- ---------- --I hereby certify that I have prepared this application and that the wor will be done in accordance with San Joaquin County j ordinances, State laws and rules and regulations the San Joaquin Lo I Health District. 1 41/ t� -- ------ -- ---- --- -'f ' ---- ----------------------------------[ Contractor) [Signed}___ - ----- -��--- (r+Ie) --------- (Plot plan, showing size of lot, location of system in r In to wells, buildings c., an be placed on reverse side). FOR DEPARTMENT USE O LY APPLICATION ACCEPTED BY - -------------------•-----•--•------------------------•----------- DATE-----1--- L---�----------------- REVIEWED BY--------------------------- ----------- DATE. .. BUILDING PERMIT ISSUED---------------------------------------------------- ---------------..; DATE ; Acte ation and or recommendations:---1--`-_Z.2>_---_(o- --------I----------[-Vt-- •- - --- -�-A- / (- r - � j --••- ----- - :----- -- -. : .... ... �- �- . / ------ Date- - FINAL INSPECTION BY:_-,-- --,_ ----------------------------- --- `SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street X300 West Oak Srreet 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California 4 ES 9 REVISED 6-59 ZM 5-62 ATLAS