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rUK UrrlC.t UJt: ................ ........... ............ .......... APPLICATION FOR SANITATION PERMIT Permit No. , ......................................................... (Complete in Duplicate) .......... �-/ "" -- • -- -- . This Per Expires 1 Year From Date Issued Date Issued -----11— Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and installherein the work desccrbed. This application is made in compliance with County Ordinance No. 549. J08 ADDRESS ALOCA N. �l7.�Gtdf• l� �� Owner's Name.._._.. .- _. -_.: ..t= Address................ . /� c o ----- Phone ft Contractors Neme.... = .. . -----.:.... Phone----...... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .... - Number of bedrooms_% . Number of baths ..l-. Lot size ----- Rr�, f Water Supply: Public system ❑ Community system ❑ Private Ul-"*D th To Water Table 0_ ft, i f 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.k New Construction: Yes 5d No ❑ FHANA: Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic +ank or cesspool permitted if public sewer is available within 200 feet.) � - Septi ank: Distance from nearestwell__ d.......Distance from foundation---J10..Liquid de._dth...... ....._Material_..... ----------- __ ?C.a---------- No. /1.f _. _ .......... .. cJ No. of compartments-. . Size t' .--X.�t ' pacify..9_0_a a-..�[ n Dispos •Field: Distance from nearest well'.-SO.. .Distance from foundation�...�6../._--Distance to neores�oJt line..-•�....V.._.. It Number of fines._!......Z.............. . Length of each line..Mtn.._ Width of trench._. 6 Type of filter material.., !y ....Depth of filter material....t .��...__..Total length----- f-Q_-T--------------•-••- Seepage Pit: Distance to nearest well......................Distance from foundation-----------------:tiDistance to nearest lot line........... ❑ Number of pits . -------------_Lining material. ------.Size: Diameter-----,- •• -------t.... Depth-----------•-----------••---- - Cesspool: Distance from nearest well.................Distance from foundation....................Lining material 13 Size: - - Diameter.....i----------------------- ------Depth.---.'_..------------ ------------------------------Li uid Ca aci I - q f P tY gals, Privy: Distance from nearest well...................................''_ _.:.._..Distanje from nearest building........_........__...._____.._ Distance to nearest lot line.............................. -•. Remodeling and/or repairing (describe):...................... ` --•---------------•----•-----..................I................._...._.._ i ---------------•-------------------------------------------------------------------- . I --L ..................•-----•--.....---•--....._... .�..r .. .� •------------•-------•-------•........................•........I-----•-----------•--------••-----•----•-------•-••-----------------------------------------------------------.............................................. I hereby certh that I have prepIred this application and that the-work will be done.-in accordance with San Joaquin County ordinances. State a s, and rules re lafi of the San Joaquin Local Health District. G �.. �:� _«�..r. ��_ (Signed) t 1 T't By:------------ .. .._...... . .. ( t le) r Contractor)- -- - --- --- - - . .................- (Plot plan, showing size of lot, location of system in relation to wel , buildings, ate., can be placed on reverse.side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. _._._ -... ,-�-~•- = " �. ,. � _.. ..............•-----------•-•--........._......•-- DATE ------ . :�lE�--�_...... --...•----..--• VIEWED BY-------------- ) ----------------------------------•-••------------.-----. -- BUILDING PERMIT ISSUED ---------------------------------------------- -------------------------- .-------------- ----- DATE.. Alt --------------------------------- erations and/or recommendations:............ .............................................------..........---------•................... - ------------------------ .........-----•. •• ..--•..................••--..........--------_.... ....................................•----.-•-• --•----- ..............................--------.--•---••---------- ....---------------- -•--- FINAL INSPECTION BY: 4A -- - Dote. ----------- .............. --..... ... 'r SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 Wesi Oak Street 124 Sycamore Streit- Stockton,California Lodi,California 205 West 9th Street � Manteca,Callfornlo ,.� '` ES 9 REVISED 8-59 2M-5-b0.ATLAS Tracy,California=�_ '