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FOR OFFICE USE: ' U APPLICATION FOR SANITATION PERMIT Permit No. ---------- ------------- ------- --------------------- (Complete in Duplicate) Date Issued -------------------------------- --------------------- This„Permit Expires 1 Year From Date Issued Application is hereby made to 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 LOCATION-------UT 31 0 ---------------------------------------••- Owner's Name-----F,Al.. ! 0.1-1_hsm,I---------------------------------------------------------------- ------------------ Phone........--------------------------- ........Q T- w.-- X77 �R''I .� y'. S_�l �? epi`l'{-------------•---...-•-------------....... -------•-••----- - -- Contractor's Namet11 -QTS,.- •-•------ Phone------• �--` ------------------------------------------------- Instaliation will serve: Residence 2- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I------ Number of bedrooms __-&Number of baths --I..... Lot size _._.I Px aQ---------------------------------- Water Supply: Public system [`Community system ❑ Private ❑ Depth To Water Table --yo- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [a—Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No R��New Construction: Yes [r No ❑ FHA/VA: Yes ❑ No ET ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /o `1� -.� Septic Tank: Distance from nearest well_rh .._Distance from foundation------ ------------.Material-.-.-..-_-----.---........._._....-.._.._-.-_--. ®� No. of compartments--------AA./...........Size-------�-X��]-------Liquid depth--- --------------Capacity.... i Disposal Field: Distance from nearest well--.--_----------Distance from foundation.IjP---.....___.Distance to nearest lot line................. Number of lines---/----------------------------Length of each line----$'4-----_-------_-_--..Width of trench.-r1141--_--_--_--.------.-.-- Type of filter materialf_Ro_ k---.----Depth of filter material---/_r---'___---.--Total length---- a_----------------------- ----- Seepage Pit: Distance to nearest well----- -------__--Distance from foundation-/_P. .........Distance to nearest lot line__.1.S7-_..-.. Number of pits-------I-------------Lining material'-7-1--l0 LJC-------Size: Diameter-----33-----------Depth-------- ----..---------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material----.-------.---_----_------.---_--_. E] Size: Diameter--------------------------- ---------Depth.---•--------------------------------- ----------...Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building--------------------.----------.---------. ❑ Distance to nearest lot line----------------------------- -------------------------•-•--------------------------------------------•-------------------------------- �T Remodeling and/or repairing (describe):-----------------------------------------------------------------------------••------------------------------------------------------- ----------- ------------------•---•-------------------------------------------------...--------------....-----------------•--------------•----------------------------- --------------------------••------------•-----------------•---- ----------------------------------------------------------------------------------------------- -----------------• -------------------------------------••--------------•--1--•--•-----------------------•- -------- 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 regulatiojoffhen J quin Local Health District. - - -- -----•------------------------------ Owner and or Contractor(Signed)-------------------------------- III��//J { / l 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--------------- f REVIEWEDBY--------------------------------------------- ----------------------------------------------•--- ----------- ---------------- DATE---------------------•---------------------------------••-- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- Aerati9tts and/or recommendations------------------------------------ �2,e�s = Y `" fG •--• b�7 - ------------------------------- •--•------------------------••--------------•---•-- ---------•---•------•---------------•--------------------------------------------------------------------------- ----------------•--- -----------------------------•------ ----------------------•----------•--- - --------------- •-----------------------------•---------------•----•------•-----------------------• ----------•--------------•---------------- FINAL INSPECTION BY: - - ------------------- Date tA�s >r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 124 Sycamore Street 205 West 91h Strut Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS