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FOR OFFICE 5E: 31r APPLICATION FOR SANITATION PERMIT Permit No. ..�� ..- ------------------- � 3 ---- - -�----- (Complete in Duplicate) 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. This application is made in compliance with County Ordinance No. 544. `s� S14- JOB ADDRESS AND LOCATION-- �.---_.- -!iQ---------------------------------- ----•--...... .......... Owner's Name........paAa,nA....XOSSe&-------•-• -----. Phone-------- -------------.......... Address-----•---------------f�y_vr..........��-�1��/ .c.Z�-----------------------------------------------------------....----------------------------....----------••-------......--- Contractor's Name----- p1 f� t?� /---•-----•--------------------------- Phone.. Installation will serve: Residence @3- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ e Number of living units: .____ Number of bedrooms .3--• Number of baths __I__ Lot size --.--____-_•_______________ _ Water Supply: Public system �tommunity system ❑ Private ❑ Depth To Water Table 449 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe{$."Hardpan ❑ Previous Application Made: (If yes,date--------------- ----) No Wr New Construction: Yes g4-0 No ❑ FHA/VA: Yes ❑ No 99---Q 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_.__._ E No. of compartments_____ _______________ Liquid depth_.V ----------Capacity__Z147_----_-- Disposal Field: Distance from nearest.gqwell-------_-Distance from foundation...) p---------Distance to nearest lot line--- 9000' Number of lines------- _ _ _____Length of each line----Pv'_'__r__ _____--.._.Width of trench..,g--/_________________________ Type of filter materiaDepth of filter material____.ier _-__Total length____._,_40....................... Seepage Pit: Distance to nearest well ___"—'----------Distance f m fo ndation__/atm.._-__-__..Dista c to nearest lot line 2r Number of pits__:___-_______Lining material-. ._Size: Diameter__. , .___..___,Depth__ s '_______________ Cesspool: Distance from nearest well-----------------Distance from foundafion---.----------------Lining material..................................... ❑ Size: Diameter------------------- ..................Depfh__.-------------------------------------------------Liquid Capacity.-._._.. ------------------gals. Privy: Distance from nearest well--------------------------------------------_____Distance from nearest building____-_._-_________________.___..-.____.._. ❑ Distance to nearest lot line---------------------------------------------------------------------- .........-------------------------------------------------•------ 4 Remodeling and/or repairing (describe):------------ -• �srs`�sc ---------. --•-------- f r -----------------------------------------------------------------------------------------------------------------_--------------------------------------------------------------------------------------------------------- --------------------I-------11-----------I--------------------------------------------------------------------------------------------------I--------------------------------------------------------------------------------- ------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------- ----------------------------- 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,aandrul. and regulations of the San Joaquin Local Health District. (SignSI ned ----- --- ------•-- __ Contractor) ed) ----- By:----------------------------------------------------------------------------- - -----------•--(Title}---- /dam'.------------------ --- ---------- (Plot plan, showing size of lot, location of system in r on to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ %--`------ ----------- ----------------------------------------- DATE---- REVIEWEDBY----------------- ---------------_----------------------------------------------- -----_ DATE------- --------•-••---------------------------------------- BUILDING PERMIT ISSUED-------------- •---•- - DAT --------------------•---------------------------------------- Alterations and/or recommendations:----- i �. . ------ ------------------------------------ FINAL INSPECT.) Tf Date F SAN OAQUI LOCAL HEALTH DISTRICT 130 South Amorfcan Street 300 oaf Oak 5rr el 124 Sycamore Slrsal 405 West 4th SInN Stockton,California Lodi,California Manteca,California Tracy,California E9 9 REVISED 8-59 2M 5-62 ATLAS