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r k 07 ,r. __..- "- APPLICATION FOR SANITATION PERMIT Permit No. . 5� 9 _ ---- ---- ----- --•-- ........._............ (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. 549. JOB ADDRESS AND LOCATION.....-_ p/!/ S t� ILJf------. f�..-_._. .- ' .................................. . . Owner's Name.... .fi�. :_..--•---��}� Q.V_+ ------------------------------------ -- ---- •------ Phone_. •----....---•-•-........... "-•--•-----•---•...-•----•--------........................"•••••-•---...--••--.. -...... Contractor's Name-------------`•�---"-•-�•-'•-��-��.�.----- ............... - ._ - -- -- -- ..-- •--._.._.. .......... Instaflafion will serve- Residence (;�-Apartment House ❑ Commercial L] Trailer Court ❑ Motel ❑ Other Number of living units: ..- _- Number of bedrooms �- Number of baths J ❑ -._. Lot size ..___�s_5..�._._X..�! U ' Wafer Supply: Public system ----------------------- Community system ❑ Private ❑ Depth To Water Table - �`> ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe Hardpan C3Previous Application Made: (If yes,date_ _..____.._-.---.) No [a/ New Construction: Yes [] No ET'FHA/VA: Yes [j No Q� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) Septic Tan Distance from nearest well_.--_-___- Distance from foundation-------------- ------ .... No. or comportments ....Size--------------------------------Liquid depth-- --• ----Capacity Disposal Field: Distance from nearest welf.................Distance from foundation....................Distance to nearest lot line................. p ® 4 Number of lines------.-------- .................."Length of each line-...._____.___.____.._____.._.Width of trench....._.._...__.,_ _ rJ Type of filter motorial______----- __________Depth of filter material_-_..__...-__.---......Total length.......................................... Seepage Pit- Distance to nearest wefl_./1/0N --Distance om foundation-____ r ��l ,fQ.--....D�tance to nearest lot line._.�rt......_.._ Ry Number of pits..__.._-,----------Lining materia!_.._. .�/L-_.Size: Diameter6`- ..Dep+h. ...... .. - ------••-- Cesspool: Distance from nearest well.......... ......Distance from foundation---.----_-_-__._...Lining material......._.._.__.___...__• ............. El Size: Diameter--------------"- ........ ---------.Depth---........• �---------•----•--...._-..----•-•----..Li Liquid Capacity Priv q - ------------gals. Y Distance from nearest well Distance from nearest buildin 9 --- Distance to nearest lot line.- Remodeling and/or repairing (describe):-•----- - --- ------------- ------------------------------------ --- ---------•- --------- -- -----------------------------------------------------------------•---••---------•-----•-----•----•----•-------------•-•-------------.............................•-----........ 1 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 regulations of the San Joaquin Local Health District. (Signed)--------- " 7��`'— (O not and/or Contractor] By: - .-Q•:----------- - 1 ----------- --------------(Title)--------.__...---- . (Plot plan, showing size of lot, location sy stem in relation to wells buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY..��- ---_-_ �-+�U -- ••----------------- - DATE. REVIEWED BY ---• ----- "... .................................................------------•------------------------------- DATE---•---•-•-••----".._......-- . BUILDING PERMIT ISSUED_ ---••---- ----•------------•-------------- DATE__.. -- ...-------• -- Alterations and/or recommendations..,.-�yt,�-� a��_�J --�� .- ---- ..... M FINAL INSPECTION BY:__... Z-/.._... G1�� -�/............................. .................. SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Stro*t 300 West Oak Street 124 Sycamore Strout 205 West 91h Strout Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 2M 5-62 ATLAS