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F-1-M%-irrit-r u4L: ------------------7--------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. -----------------------------------A---------------- (Complete in Duplicate) I. -------- ------- ------------------------- --------------- This-Permit .Ex pfres I 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------ ........ ..4, Owner's Name.........aA -_,0_, V--- ........ Zoe ...... ...........:57,1?m - ------------------------------------------------------ Phone..................................- Address. ......................................................... Contractor's Name------- ...... sS. -------------------------- .......................... Phonal/ Installation will serve: Residence 11X( Apartment House Commercial El trailer Court 0 Motel [3 Other 0 Number of living units- _.'e—l' Number of bedrooms Y Number of baths A?--- Lot size —--------- ... -Community sysf&m-0F4_afei7 -b - — Water Supply:' pu6lji:iySt6rii'E1 Depth to Water Table VZ? ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ andy Loam El Clay Loam [] Clay El Adobex Hardpan ❑ Previous Application !Made: jif yes,date-I:------------------- No New Construction: Yes E] NO FHA/VA, Yes 0 No C] TYPE 'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I ' 7i tic Tank: Distance from nearest well__--__.____-__-_Distance from foundation...... --------Material---- No. of compartments-i- -Size__---_---------------- _-Liquid clep�h--------------------------Capacity. - - I----------------------- ......... Dixspo I field: i .'Distance from nearest well_/e40."_Distance from foundation----40.. _----Distance to nearest lot line m q - 71�Xl '-------- u Number of lines____- ----------------Lengih of each line------4_0----*__ Width of trench------2 . Type of filter material....�EQCX�n----Depth of filter material----/9---- __..__Total length------ --- �Seepaqejit- Distance to nearegf-well-4-VO-f----Distance from foundation--/47-./.....Ast Dce to nearest lot line.,S.......... ' 11 ng-' material__W_04�----Size: g�&r,44F Number of Pits':_/1 -------Linin Diameter__,91� i Depth__. _i� Cess po,ol,: %J`—Distance-from nearest'well-.---------------Distance from foundation-------------------Lining material_._...__......._______....__.......__ ' - � t ...................... ❑ pp Size: lJieZ;er-.--------------------------------------Depth----•------•---------------------------------------Liquid Capacity.' -------I--------gals. ----------- Privy: -Distance,41m nearest well---------=n------- -1----------------------Distance from nearest building----------_----------------__-------- ❑ Distance f; nearest lot line_______________________________________________ - ---------------------------------------------------------- ----------------------•------------- 9 or 'repairing Remodelin and/or (describe):._ 7>16Z i , I F - -----efe�,,�. ---- ........ -.-;,------------------------------ ------------------------- ----------- ---------- ------------------------- A, -------------Z.4:2 -- --------- -------------- -------------------------------------------- ---------------------------- ---------------------------------------------------------------------------- I hereby ceirfify,thatj have`prepared this application and,that the work will be done in accordance with San Joaquin County ordinances State laws,'and the/aleynd regulations Lof �h� a' n Joaquin Local Health District. (Signed). -- ---- --------- Owner and/or Contractor) ............... ------------- By:_...................................... ---------------- ....... --------- ------ _(Title) .. ---------------- (Plot plan, showing size of lot, location of system in relation fo'wells, buildings, etc., can be placed on reverse side). FORD ARTYkNT USE ONLY ---- --- -- --------------------- APPLICATION ACCEPTED BY----------- ---------------- DATE---- .. __.`.. _.- REVIEWED BY---------- ---- -- ---- --------------------------- --_--------------- - ----------------- BUILDING PERMIT ISSUED_........................ --------I-------- ----------------------------------_........ DATE.._._-.._.__._.-------------------------------------------- Aherafions and/or recommendations:.________-___________________-----------------------------------------------------------*-------------- DATE--------------•---------------------------------------------- ------- ----------------------------------------------- --------------------------------------------------------------I——--- ..... ---- --------------------------------------------------I-------------------------------------r------------------------------------------------------------ -7 ----_------------- -------- ------------------- ---------------------------------------------------------------------------- --------------...------------- /-------------- ................................ -------------------------------- ------------------------------6-------------------------------- -------------------------------------------- ........ ------------------------------------------------------------ ---------------- ---------------------------------- ----------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:---- - ------------------ ------- Date---------- ...................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 48 9 REWSE0 0-59 2M 5�11 ATLAS