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FOR-O FILE USP: --------- ------------------------ ------ -____- APPLICATION FOR SANITATION PERMIT Permit N'o_..Z.Y_ (Complete in Duplicate) 7l ! This Permit Expires 1 Year From Date Issued Date Issued __..___.f__ x 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. S49. /� JOB ADDRESS AN CATI N-------------- �,1 �.------�-1ye .------(�2/�.......---------•--- - - -_---•-___-----------•------------ Owner's Name----- �--------- -------- Phone---------------------------------- Address-------------------•----------- Q �- - --- r -- ��:-t1.� .�T - Qd '" Y - r-.-.-----••---•-------•-•-----------•-•---•-------•-------_---Phone --................................... Contractor's Name Installation -•--.....------•- will serve: Residers Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: umber,of bedrooms _L.__ Number of baths ___A Lot size _.�D__�_-_114?_________________________ Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table457_7�"ft. Characfer of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[5"H�`ardpan ❑ Previous Application Made: (if yes,date--------------------) No Ele"New Construction: Yes ❑ No D�FHANA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: Ff (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (� Septic Tank:,, Distance from nearest well_________________Distance from foundation-------...........-Material---_____-______-________________________________- d1A-- No. of compartments---------------- -----Size______________- __Liquid depth--------------------------Caaci .......... DispoosaField: Distance from nearest well------ Distance from foundation.....r0---__....Distance to nearest lot !lY of lines________1__. __ Length of each line.- �A_�.............Width of trench._CP_k_/��/sf/ ¢ Omber pe of filter material-- •--Z--rrP� Depth of filter material-_--/_&-_/-------Total length------- �.�--•----•-.--••------•_ Seepage it: Distance to nearest iwell______`^`-_-_-___Distance from foundation______/�_�__.Distance to nearest lot line-.�2....... ¢� q f�umber of'pity______!_____________Lining material----- v�_�t�_.Size: Diameter4:?j_.`/___-_-_ Depth__Q'S.."____..________ e spool: / Distance from nearest well-----------------Distance from foundation____________.-----Lining material__________.._______.___________._._._ ❑ Size: Diameter--------------------------------------Depth-------•--------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well---------------------------------------_---------Distance from nearest building------------------------------------------ 11 Distance to nearest lot line---- -•-•----•--------------••---------------------------- 11 Remodeling and/or repairing (describe)---------------- r . -----•------•--•----•---•------------------------ -------------------.-- --------------•--------- -----------------------------------•---------------------------------------------------------------------------------------------- ----------------------------------------------------------------- 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,IT14rules and r ulations of the San Joaquin Local Health District. (Signed)..,-..... _�. ----- -- ---- - - - ---------------------------------------------- ---------(Owner a d/or Contractor) RY: :.� (Title) -------------- - ------------ - ---------------- ; Plot Ian, showing size of ! ocatio of Sy stem in relation to wells b�ul Ins etc. can be laced on reverse side). ( P 9 � g . p e] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----r-- 1_ ---•- - —` `� -------' ----------------------------------- DATE--- 1 {� �' Z-------------- I -------• DATE----------------------------------------- •-------•---- BUILDINGPERMIT ISSUED----••--_---------------------------------------------------—..................___------------. DATE...........--•---••--------------------------------•-------- aerations and/or recommendatio s:------------------------ •-------... 1 �e ... -------------- ----•--....,.. . ----- ----------------------. --_----------------------- ---- FINAL INSPECTION BY:--- --i--------- -----. Date_.._.__._r. L_--0--__---^-- --------------------------------- ----------- - SA - •-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9111%Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS \