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FOROFfic�usE•• ; APPLICATION FOR SANITATION PERMIT Permit No. nw----- (CoMplOb In Duplicate) Date Issued------------------------ - This Permit Expires I Year From Date issubd ........... ..................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and IN+611 the Work herein described: This application is made in compliance with County Ordinance No. 549, JOBADDRESS AND Z----` .---------•--••-. ............................... .......................... ............. Owner's Name.......... ......... .............. Address........................................... ..... -.............................----•--......................-- ..................................I.............. Contractor's Name.........i..................... .......................•._............................-.... ....................11-.:--,...............4Z....Zz—............... phone.......:...:..........::..:::::.::. � r Installation will serve- RasildsincaK A*par+menHouse 0 Commercial El Trailer Court [:1 Motel 0 046f M Number of living units: Number of bedrooms —2.—Number of baths /.. Lot site .........*�-- K Z..... ......... Water Supply: Public system 9—Communify System Ej Private [ Depth to Water Table 2.--eft, Character of soil to a depth of 3 fee+: Sand [] Gravel [I Sandy Loam Er'Clay Loam [] Clay 13 Adobe 0 Hatelpati Previous Application Made: (If yes,date....................1 No 2-�New Construction-. Yes [:] No 9-4HA/VAi Yes El NO LE-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.... ... ....Distance from foundation---/,v...... No: of compartments............. .......Site.... Liquid �y.......... 2--- Disposal Field: Distance from nearest well....-1-....Distante from founclatloh.—.2—m......Distance to hbardg+ 10+ 141me........7,.-M Rf Number of lines ...... Length of each line.... ;2..............Width of french...............11111111111W... a"+"e of filter material-----S.............Total length....-ai......... .....4--. Type of filter m rial..... -/411-x;, Seepage Pit: Distance to nearest well......................Distance from foundation....................Dista.rice to nearest lot line......_....::..... ElNumber of pits----------------------Lining material.......................Size: Diameter............... ........Depth.........;4..........z----------- Cesspool: Distance from nearest well.................Distance from foundation............... ....Lining material............._..___......._...._..... Size: Diameter... a ..........-..................I...�Depth-..............—..........--...................Liquid Capacity............................9 Iis Privy: Distance from nearest well.................................................Distance from nearest building.........................:...._.._........ ElDistance to nearest lot line------ .................................... ............................ ............................................... ............... Remodeling and/or repairing (describe):-------- ............ .......... ................ ----------7........ ........... ............... ------- -----—-- ----------------------------------------- ------ ................................................... ............ ----------- ............... ............-------------------------------------------------•--.... .............................................. 1:r-er-e-b�v�certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancaj, Late laws, and rules and regulationsof the San Joaquin Local Health District. (Signed).... - ,z,- .:-°.---------------------------------------- ------------------------------.(Owner and/or Contractorl By:......................................................... ----------------------...................................................(Title)--------I—.......I---- ........ ------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- ----'------ ------------------------------------------------------ DATE..--------- ............... REVIEWEDBY---------------------------------------------------------------------------------------------------------- ---............. DATE....................I...................................... ------------- --------------------------------------------- BUILDING PERMIT ISSUED................ ............................—--------------.......................... DATE................ Alteraions nd/or recommendations:_ ___._.—.s__________________________ ----------------------- ----- r.... ........ Z -- ----'------- -------............... �`.,fi- •.-w- ........... ... ............ ----,�-F..Z... .. 3 _7 ............ ----------e...... ...................... ........................................................................................ .......... -------- ---------------------------------- ....................... ........------------------------ -- -------------I------------------------- ......... • ---- -- ....... . .............1�1 ............ ......... .. F K;a 0&47/n5P EC7 -------------------------------------------------------- -------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak$Treat 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S.B9 2M 5-61 ATLAS