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FOR OFFICE USE: 14. .�_� APPLICATION FOR SANITATION PERMIT Permit No. .......j.t A. .i.. ------------------------------------------------------- (Complete in Duplicate) (n Date Issued --------------------------------------------------------- This Permit Ex ires 1 Year From Date Issued Application is hereby made to the Says Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ord'I ante No. 549. JOBADDRESS AND LOC AT N. 7�6 ---------------------------------------------------------------------------------------.......................................... Owner's Name-- ---- ------... . - -- ---------------------------- Phone------------------------------------ id 2-y ------------------------ - iaay Address------------------ ......G1,•(it�/�• -- ------------•-------------------------------------•- Contractor's Name--------. ....----------`-3-11)--------------------------------------------------------------------------.----.---------.------ Phone................................... Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other'm Number of living units: -. __ Number of bedrooms --3,. Number of baths __... Lot size --------------- Water Supply: Public system Community system El Private __ Private Depth To Water Table ft.� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [May ❑ Adobe❑ Hardpan ❑ `fit Previous Application Made: (If yes,date--------------------) No g3"' New Construction: Yes ❑ No Ej-' FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' n - 7 Distance from nearest well-----------------Distance from foundation-------------------.Material-----.........----------------------------------- No. of compartments--------------------------Size--------------------------------Liquiid depth-------------------------Capacity-----------------` .. Dispos �glfl� Distance from nearest well-----------_-Distance from foundation./_�_-----------Distance to nearest lot line__•^-..... ow► Number of lines.___.--- _ ___.__ Length of each line----�06-�---_r.--_-----Width of trench__-2. -.'-'................... Type of filter matenal�_/1.4_C _------_Depth of filter material.../_$...............Total length-----/PD__--------------------------- See�pag �Pi :/ Distance to nearest well----.__--------------Distance��rom foundation__.0_r__.__.__..D•st rice toy,nearest lot lin .--�-..F...__. [E �/ Number of pits.-�---.-. -__Lining material___(_l__oG't------Size: Diameter.._�i�#�.(,.Depth... .. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------..--.---__-_- ❑ Size: Diameter---------------------- ---------------DeP'th-- ;-------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------- -----Distance from nearest building__--___---_----__--_-_-_----__-_--_.--- ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):---------------------------------------------------------------------------/--------....------ -•--- ..........-------•----•----------•------- I ----------------------------------------------------------------- r d hereby certify that I have preparedq1Z ion and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rules and rega San Joaquin Local Health District. s (Signed)------------------------------------- --- -------------------------------------•----------------------------(Owner and/or Contractorl BY:. -------- - (Ti+le) = - .....(Piot plan, showing size of lot, location ofation to wells, buildings, etc., can be placed on reverse side). _F,OR D!fAfTMENT USE ONLY APPLICATION ACCEPTED BY------- -------•-----•--•----------- DATE------------ REVIEWEDBY---------------------------------- ------------- ------------------ ---------------------------------------- DATE----------------------------- •---------------------- BUILDINGPERMIT ISSUED--•-........-------------------------------- --•--------•-•--•---------------------------------------- DATE------------------------------------------------•-•-------•- Alteraons an /or recommendations:-----------------------------------------------------•-----------------•-••-- ........... .................................................... - ..1_j.. _.t: •c�� o -/v- --------. ----- S.v ---------•/ -� ��•t ..�f_, �-' � ------•--••---•--•----------•--------------------••--•----•---------- ---------------•------•----•--------------------- ------------------------------------ -----------------------•---------.-------------------.-------------------------------------------------------------------•--........ .. FINAL INSPECTION BY: - R` --------._._ Date-.--------� ----._�_`�.- ._._4.�.---------------•---•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 2M 5-62 ATLAS