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Ubt: ----------- ------------------ ---------------- APPLICATION FOR SANITATION PERMIT Permit No. .......r...........X61 --------- (Complete in Duplicate) 2_� Z Date Issued - ----------- --�a---------------------- ------------------ This Permit Expires 1 Year From 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 complian6e with County Ordinance No. 549. f. ---- -- --------- -------------- JOB ADDRESS AND LOCATI0N..'..L_:Z---0------UJAQ_�/ ....... ---------------I---------------------------... -------- --------------------------------- --------------- ---------------------- Phone-017. ------------ Owner's Name-_( Address. Z_1_42:1 --- -------- Contractor's IUAAA� ----- - .... . ... �Ap ..... .... - - ------------------7--------------------------------........ Installation will serve: Residence M:--kpar Mnt House Ej Commercial E] Trailer Court ❑ Motel ❑ Other [3 Number of living units: .1..... Number of bedrooms _Z. Number of baths _1... Lot size ... ------------------------ Water Supply: Public syst;rn E1___'C'cmrnunity system 0 Private ❑ Depth to Water Table ft. Character of soil to a depf"f-3 feel: Sand-'E] Gravel [] Sandy Loam Ej Clay Loam E] Clay [I Adobe 9"A'ardpan 0 Previous Application Made:-,..(If ye's;clate. -_____¢______.___y No E] New Construction: Yes E] No ❑ FHA/VA: Yes 0 No [B-- TYPE OF INSTALLATION AND SPECIFICATIONS.- (No septic tank or cesspool permitted if public sewer�.is,ay.ailable-,within-.200,ferst.)-- I I . Sppfic Tank- Distance from nearest well_________________Distance from foundation..._-------------Material...................................... 1, 4 - ........... No. of cornparfrr�ents i3 � -----------------I---- Size ----------------......Liquid depth----J------------------Capacity..........t............ -- --------- Disposal Field: Distance from nearest well_�W__D�Istance from foundation.____j.PVt`.Distance to nearest lot f4"7' e -------------------Width of Number .of lines ------- -----------L�ngth of each line___4-0- F trench____ -- ---- --*----------- jype,oi4ilter�xhoteria Depth of filter material-----I-q............Tot"I length___..4_._D...........----------------- 4 a Seepage/Pit: Distance to nearest�well- -Distance-from foundation___.10-----------Distance to nearest lot I' .......... Number of pits- ------42-kiL4.4.Size: Diameter_-__.' ...........Depfh__...:�2-_, Cesspool. Distance from nearest�,—ell=j----------6istance from foundation--------------------Lining material_____________________--------_-_. - d ❑ Size: aterial---------1-1--------------------- Size: Diameter-___I---------------------------------D6pfh---------------------------------------------------Liquid Capacity----------------------I-- 1 7 ?I "r gals. Privy: Distance from nearest well------------- -----------------------------------Disfan-c-6 froirn nearest building------------------------------------ ... Distance to nea est lot line------------------�- g Remodeling ine----------------- Remoaeling and/or repairing (describe):_____-_- --------------------b----------4-------- ...... .........0 --------------- ----........ .........................-------------------II ------------------------------------------------------------------------------------------......------------------------------- --------------------I........................... ------------ ------------------------------------_----------------------------------------------------- ------------- ----------I------------------- IN I I -----------------. ........... ------------ .......-----•---•----------------•-•-------------------- -------------------------------------------------------- I hereby certify that I have prepared this application and that the work"will'6i;*done in accordance with San Joaquin County ordinances,/Stafe laws, and rules and regulations of the San Joaquin Local Health District, ---------_----------------- (SigneiQ)�_-------- _----------------- ------ -------- -------------- ---------- _�_ ___.(Owner and/or Contractor] By:---------- Title)----- ------------------------------------------------------------------------- ....... 4;�j"'-: ----------------------- io .; i;t I (Plot plan, showing size. f lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse 08e). -'Z-0' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED I 1:-: :-� __ --- -------------------------------------•----------- . ..................-..--.-..--.-..--..-.-.-.--.-.-.-..-.-.--.-..-REVIEWED BY--------- DATE.-........... BUILDING PERMIT ISSUED-- ...--------------------------------------- ----_---------------------------------------------- .-.- DATE----------- Alterations and/or recommendations:..--..------- •_____________ ---- ---------------- - - •-•--------••--------------------- ------------------------- ------:;�.................. . ........ pa ------------------------------ --------------------------------------- --------------------------- ---------------------------------------- .........5--- ---------------------------------------------------------------------------------------- ------------------------------------ ........ ----------- ------------------------------------*-------------------------------------------- --------------------------------------------------------------- FINAL INSPECTION BY__�2.... ------------------------------ Date--- ....6 A SAN JOAQUIN LOC-rA-A L HEA'A LTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EG 9 REVISED B-59 2M 5-61 ATLAS