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FOR OFFICE USE - ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ........... --_--_-- - ------------------------------- --------------------- (Complete in Duplicate) ° E z1 -------------------------- This Permit Expires 1 Year From Date Issued Date Issued ___. _.._.�_.... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thism application is. ade in compliance with County Ordinance No. 549. `rte-'�tfv Sser/'tet ( -CT- 46 .� JOB ADDRESS D LOCATION Il ..CEN ( f__T _ �_�.....- ,,p ® ' ----------------- Owner's Name- �_,!_ ��------ --- I-:> NQ/.4' i�^y\1/ Phone... Address------------------ -----------------------..---------------------------------------------------------------------•..................................................- ---------------------------- Contractor's Name-- Y 1 _ _L -------V--__-`.�2_G&------------------------------•-••------------------------------- Phone............... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Turf Number of living units: __ ___ umber of bedrooms_. Number of baths _^.__. Lot size 1AQ_�_1�p._.771 --t�•_I!�kF Water Supply: Public system [Community system ❑ Private ❑ Depth To Water Table ______;_ ft. 13Uj Lul N C-- Character of soil to a depth of 3 feet: Sand CE'Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [� Previous Application Made: ;If yes,date__._ _.............) No New Construction: Yes n'No ❑ FHA/VA- Yes ❑ No �] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .__..__.Mat rial___CQJq.CRa-T. _=.------_� ¢ Septic nk: Distance from nearest well.fli'�Q_l�l�Distance from foundation__ .._.. � No, of compartments ____ Size ___ ^moyi 6 X____ _Ca aci P ��- �•-------- �----------Liquid depth------- ---------------- P tY� ---•'`�-.._��...._-�!it Disposal Field: Distance from nearest well—KON_E1 Distance from foundation.___- ._._.Distance to nearest lot line.-_'_-t--- ._ [� Number of lines---------..3______.______.____Length of each line_.��_`4 __ f ii 5-.Width of trench......f.2 �_.___--------------- ------ _____________ �O Type of filter material._..�0.e�__Depth of filter material____._/__________Total length-----------1,f_5._________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line________.__...-. (] Number of pits----------------------Lining material--------------...------Size: Diameter----------------------.Depth---------------------------------14 s. Cesspool: Distance from nearest well--------------_Distance from foundation--------------------Lining material____._____.________.._-_--_-_-_--- • � ❑ Size: Diameter--------------------------------------Depth---------------------------•-----------------------.Liquid CapaciY - gals. I/� _ Privy: Distance from nearest well________________________________________-------Distance from nearest building-----------------------....___._____-___- ❑ Distance to nearest lot line------:------------------ ------------- ----- --------------••-•------.---------•---•------------------------------------------------------- Remodeling and/or repairing (describe):�------•----------------------- ----------------- --- -�ry ---.......,I� ---------- ---- -- ------------- .------Nr B07__ nn"------1 �=r' � }rep --------------------- _ ------ ------- rv�_ n1' ------ H--------ON -----------------------------------------------------------••---------------------------------------------------------------------------------------------------------- t------------------------------ --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. t,(Signed)-------------------------- --•----_._.......-.-----------------------------------------------------------------------------------•------... -------------(Owner and/or Contractoi')%e,� By— ------------------------------------------------ ---------(Title)---------------------------------------- ----..- (Plot plan, showing 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-------//--r------------ ---- -----��----- REVIEWED BY------ --------•---------------------------------------------------------- - DATE------------------------------------ ---------------------------------------------•-• ------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------ --------------- Alterationsand/or recommend'afions:--------------------------------------------- --------------------------•--------------------------•---------------------------••----------------------------• 1 -•----------------••-•---..-_-----------------------•--------•--------------------------------------------------------•--- ---------•-------------------------------------------------------------------------------------- ---------- ------------------------------•-•----------•------- ---------•---------------------- ------------....--••---•---------------------•---------------------------•-••------------------ -------------------------------------- ------------- - ----- - ............. -- --'----------I--------------------------------••------------------------ 1219 FINAL INSPEC�I Date /------ ��f�--._�-�- SAN JOAQUIN LOCAL HEALTH DISTRICT -r 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wool 9th Street Stockton,California Lodi,California Manteca,California Tracy,California REVISED S-59 2M 5-62 ATLAS ��