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li FUROFFICE USE: ----------------------------------------- --------------------------------------- M---- APPLICATION FOR SANITATION PERMIT Permit No. .............. w A. (Complete in Duplicate) ------- -----=----- This permit Expires 1 Year From Date .Issued Date Issued Application is hereby made ato the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATiO - ----•-_-- P[. -�---7•-l-'Z--- Own ` - Owner's Name.- ..---Y_-'----._.1C/-1:-x ---Q/cQ /_ � �J ------- Phone...... z— �� ------------------------------< ------------- Address •-1!/•-------- -•--� w-yd-----•-•-•--------•----------- ---------•-•------------------------•---•----------------------•---•----••----••--•- ,I . Contractor's Name...... j ---------------------• -------.------------------------------------------------------------------------------. Phone............................... Installation will serve: Residence [jY' Apartment House E]/Commercial [I Trailer Court ❑ Motel Other ❑ Number of living units: _- -_ Number of bedroomsX-- - Number of aths -lam-_ Lot size ....... Water Supply: Public system ❑ Commuriity system ❑ Private Depth to Water Table ��ft. 1 � Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam Clay Adobe❑ ;7o n ❑-, Previous Application Made:' (If yes,date--------------------) No New Construction: Yes No ❑ FHA/VA-. Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet.) , /y Septic Tank: Distance from nearest well-- --..Di9tae om foundtion---- • �T . . - -�_ No. o compartments_-----�----.-----.-Size_____- -_..___ Liquid depth....... --------Capacity... -Q« fDisposal Field: Distance from nearest well-&O from foundation #o nearest lot line.......a.•t.-:.. 'filter lines------------ ------------Length of each Eine----__-_-: -------.-.Width of trench.---- ----------- - i NurrtberlIter material__.,L�-per�(-.-_Depth of filter material___-„ - Seepage --_-.__--Total length....•.•..-. ----------- Type Type of Pit: Distance to nearest yaell--_/0-11)-_- � -Distance from foundation.. ..id.._._.Distance to nearest lot Number" ,of pits-__-- ---------------Lining material_._1FC--CA..Size: Diameter-_- - ----.Depth---Z.,5 7---.---_-------- ll. Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material----._---------__---__--- 1 ❑ Size: Diameter------ ----------------------------•- Depth---------------•---•--------------------------------Liquid Capacity---...._----------.----•-gals. _ } Privy: Distance from nearest well---------------------------------------.---------Distance from nearest building------.__-...--_---_--__----__---.-.--.... k ❑ Distance to nearest lot line---------------------------------------------- ----------------- --------------- Remodeling and/or repairing (describe)----------------------------------------------------------------------- = -------•---------•------------------k-------•.-----------------------------------------------------......------------------------------------------------------.-----------------------------------......-.. iM I h eb y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan t wT, d Irrules and regulations of the San Joaquin Local Health District. Si ned ~ C. --_-_----------------------------------(Owner and/or Contractor) f 6 �I (Title) __ _ ______ _______ (Piot plan, showing size of I it, location,of,,system'in relation to wells, buildings, etc., can be placed on reverse side}. %1 N —FOR DEPARTMENT USE ONLY t � APPLICATION ACCEPTED,BY- DATE-- -----------• -------- �REVIEWED BY.... -----------------IV----------------- ------------- --------•----- --------------------- DATE------•------•-------......------------------.............. !� BUis ILD.�I�N,G'P�ERMIT'155UED.j._... . ........ - _ Alterations a /oC recommen •-•--•-- ----- _ �. -•- ----- - ------ ---- --- V --- -----••------------------------------ F--- ------------ �. '.. - - ------------------------- - -- = - -------- --------------- ...................... -. - �1 -- ff4 FINAL INSPECTION BYJ1. ................ D _J�--------------------- SAN JOAQU LOCAL HEALTH DISTRICT 130 Sough American Street i 300 west Oak 5 at 124 Sycamore Streel 205 West 9th Street Stockton,California Lodi,Califo nia Manteca,California Tracy,California EB 9 AMSED B-59 YM 5-61 ATLAS 6