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FOR OFFICE USE: ----------- g o J APPLICATION FOR SANITATION PERMIT ✓ Permit No. ...�C-. ... � ------ (Complete in Duplicate) � 1 ---------------------___.__...._-__._._.__._________.__. This Permit Expires 1 Year From Date Issued Date Issued ___../ X12— /qv--®.3 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 LO29--- Address N 1..1- =------------ '�'= 7phone --•-----•-------------------------------- N•--�D� 7 Owner's Name f Lc.� . • -----------------------------••------------------------------... ... �[ d -•••--•--• - y1. _3...- -mac h- 1 Contractor's Name t --- Phone................................ Installation will serve: Residence.( Apartment House ❑ Commercial ❑ Traile� Court ❑ Motel ❑ Other ❑ Number of living units: .. Number of bedrooms _r-. Number of baths .--/.?'Cot size ---------/_ ...............-------------- ............ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _4 ft. P Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy loam Clay Loam Clay ❑ Adobe❑ Hardpan C1Previous Application Made: (If yes,date-------------_.__--) No� New Construction: Yes No ❑ FHA/VA: Yes ❑ Nam t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep is Tank: Distance from nearest well_ �l_..Distan from foun tion._._--162-..__.Ma real....._ No. of compartments--Y.----- ��- _- --Liquid depth-----�,��"-------capacity...f� .� -----Size-- --- - Dlsposal Field: Distance from near st well.4_D__.__._Distance from found on �� Distance to nearest lot line............ -. [ f Number of lines_________ ____ ____________ _Length of each lin . �;,_ G?_.Width of trench.___ __ __ .___......... _.-. T` ----------------------- Type ' of filter materiall_:lj '_ _ .Depth of filter material length___-.,�.. ... N Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------_------. - ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth.-.----.----------.-•--------_--- Cesspool: Distance from nearest well-----------------Distance from foundation___-._---_-....___.Lining material..------------.-----._--__--____----- Size. Diameter----------•-------------- -De th--•--------------.---------------------------------Liquid Capacity b - Privy:' Distance from nearest well--------------- -------------- -------- _.__Distance from nearest building____ __________._..........._._ ❑ Distance to nearest lot line-------------------------------------------------------------------....................----------•-•-----•--•--------•-••-------------------- Remodeling and/or repairing (describe):-------------------------------------------------------- -----------------•-•-•-----•----------------.............................................. --------------------------••------------------••---........---••--------------------....-..----------------------•--------.-.....---------------••---------------•------------........---------•------•.-----•---------------- I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances tate laws, and rules and regulations of the San Joaquin Local Health District. (Signed)..(A ------------------------------------•-----------------------------•--------------------------------(Owner and/or Contractor 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 C APPLICATION ACCEPTED BY-----------------�---------------------------------------------•-- •--------------------._..._•_ DATE--------------------------------------------- --------------- REVIEWED BY--------------------- DATE---- .,t- ------------ BUILDING PERMIT ISSUED----------------------------------------- ---- ---�-------------•-------------------•---- DATE--------- --•----- --- - � --- ------------------------ Alterationsand/or recommendations:-•-------- ------ - -•- ------- ---•---------------------------------•---------•••-----------------------------•-•----------------------------- ---------------------------..-.------------------------------------------------••---------------------------•---------------------------------------.....---------------.--•-------•---------------•-----------._.. Date —6Z � -----------------------------------------FINAL INSPECTION BY: SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 203 West 9th Street Stockton,Callfornia Lodi,California Manteca,California Tracy,California ES 9 REVISE[) e-$9 2M 6-61 ATLAS