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rUK vVM.0 "C; - ------...J .---- .................... p APPLATION FOR SANITATION PERMIT Permit No. ................................................. (Complete in Duplicate) ' Date Issued This Permit Expires 1 Year From Date Issued ttpplication 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 Ordinan a No 549. B ADDRESS A OCATION� �. ..:?�. .. �'r/�-K�4`-.'--�--�-•�--u �" Mite-t..�. Owner's Name...... -- - - - --- - -- ------ -------.-.-.__._--------..................-----....-Pho ---------.-.................. dress.-.\la.S�.. LL ]]33-tt -------- - -----............. .. - ..-. .,Y"-----------.... _.. . . !bntraetors Name.-....--••- �S.`--"u-+�----- ..�1--1-..._e .. .. .:GA..,fN............................................... Phone.-..--....-_...--_-.-_...--I-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ rte _ Number of living units: ----'.- Number of bedrooms ....YNumber baths ...J-.. Lot size ......4_.C'i.�...a- t_4+1--------------------- tater Supply: Public system ❑ Community system ❑ Private �epth to Water Table ........ ft. haracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [Adobe❑ Hardpan ❑ twevious Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) '%ptic Tank: Distance from nearest well.................Distance from foundation..'.-.............Material------------------------------------------------- ❑ No. of compartments.....-.--...............Size----------------.......---'--'--Liquid depth----.-.. ..Capacity------.----_--_. .._ `sp ,;�I,Field: Distance from nearest well......%5.97..r Distance from foundation...IA_.'r....--.Distance to nearest lot line.............. Number of lines........ ....../..� Length of each line.......!-- -l�...r.----.Width of trench...... ...�................... Type of filter .........Depth of filter material......,«..........Total length........L-Cl./!----.....-.............. :epe Pit: Distance to nearest well-----�.QG. ....Distance fro,m_ff�oundation- sl!.j6._....---.Distance to nearest lot line-. Number of pits---- -----------Lining material-. MI--rZ,....Size: Diameter.....- .........Depth..;_V.S�................ Cesspool: Distance from nearest well.................Distance from foundation....................Lining material..................................... . ❑ Size: Diameter......................................Depth---`---......--------------...------.........Liquid Capacity....................... ...gals. rivy: Distance from nearest well.................................................Distance from nearest building-...-_-_-...._-------_------------- ❑ Distance to nearest lot line---------- -'-----..................................................... ..............-............-........................................ I,,,,amodeling a /or repair' 9 (de ribs):_.... "�-----I a� ---, r�.�'-• S-~- --•---- . .................... .................. .....................-- - ... ..-....- ............................. - - - — — ............................. ...................--------------------....--...........-----......-...... ................. ......--..... ... .......................................................... see 1 hereby ce • that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a la , and rules ulations of the San Joaquin Local Health District. ieeigned)-.... --...................... -- ---------- ---------- ------------...--------------------------------- ----------- end/or Confractor) By: ..- . . ..... -r------- - e - --- ...... -- ...- lr+le)---•----------------------------- ---- -lot plan, s owing size of lot, location o sys+am in r lotion to wells, buildings, ate., can be placed on reverse side). FOR DEPARTMENT USE ONLY PPLICATION ACCEPTED BY - �-- -------•---•-------------------------- DATE....I.......- ----- ............................. b.sEVIEWED BY.............................................................................................................._ ............ DATE.................__........-•—.................... WILDINGPERMIT ISSUED.............................................................. -..................................... DXTE..................-..........................---....... 'Iterations and/or recommendations:......----......... ......---.....-- ----...-------------......----------------....-----..-_-.-----•------•--•--......................... V ---------- ----- -- ----------------------------------------------------------------------- ... ........................ .................. ..................................................... ..................................................................................................................... ---------------..........................--------------....................... ..................-- ......................................----................................_.............. ............_.......................------...................-----.............. - . _. ..................... . .. . .... ----------.......................----- .................. .....................---- r. FINAL INSPECTION BY:...... :a:..-- _:_..;.r._:.._.__... _._....... Date-,_/./,..----- 51.1� ..._-••----._._._........................ L SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hasellen Aye. 300 West Oak Street 124 sycamore Street 205 Wen 91h 51reet Stockton,Callfarnia Lodi,California Mantem, California Tracy, California SCS 9 FEVISCO 0-59 3M 3-'63 F.P.c O.