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1-UKUH-If.E 1_15E .��----------------------------- ---------------- • APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------- ----- Q [Complete in Duplicate) Date issued ---------------------------------------------------------- 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 compliance with County Ordinance No. 549. JOB ADDRESS AND YCATION-----..c.i -Z� Z.----- W -a---------------------------------------•--•--------•--• •----•----------------------- Owner'sName ------------ Phone................................ Address---------------------------:57 '` ------------------------------------ --------------------•-------------•----------------••---• Contractor's Name ----•-------•----------- Phone...............---•--------------- L Installation will serve: Residence,[ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms •_2--Number of baths A____ Lot size ___________________ 1� S Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table -------- ft. � . Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay's Adobe❑ Hardpan ❑ Previous Application Made: llf yes,date............._.__--) NoNew Construction: Yes ❑ No [_ FHA/VA: Yes [I Not' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation---------.----------Material................................................. ❑ No. of compartments--------------------------Size----------------------------.---Liquid depth--------------------------Capacity----•----------•------- \ Disposal Field: Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line-------.......... Number of lines-----------/----------------------Length of each line-- ,_j __- _Z)-__-_j�____..Width of trench---- �_--------------------- Type of filter material---------�------=-------Depth of filter material------IJ__________Total length------- "V y � Seepage Pit: Distance to nearest well---------_` ---------Distance from foundation----��____ _L.Distance to nearest lot 0 Number of pits-- j-------------Lining material-----------------------Size: Dia�ne#eF--"�/��------.Depth------14--.-------_----.-- ` Cesspool: Distance from nearest well-----------------Distance from foundation-----------------_Lining material__.___________-_______-_.___.___.___. ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------- -------Distance from nearest building_____..___---_--____---•----_____________. ❑ Distance to nearest lot line-----------------------•-------------------------------------------------------------------------------------------------------------------- Rem delinq and/or rep 'ring (describe):_____f l ,______ _ _._. ._ __.?'1_________ -----------��_______-�_° _L 4-L t}5#abL2oa� _ .c ._ .._..- -�� .. _..._.. ......- ------- -------------------A-a-`v-------- A-�•-�--- --- -- ��,�........ ��- ---- -------: UU; ---------e---�d-�---- a�. - -- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ules nd egulations of th San Joaquin Local Health District, (Signed)- - - ------------------------------------------------.--------------(Owner and/or Contractor) I By:------------------- - -- Title . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i i� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - ----- :--------------------------------------------------- DATE 7 ..--------------•- REVIEWEDBY----•-----•------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:--- ------------------------------------••-•-----••----•-••----------•--•--------------------------- --•----. •-------•----------------------------- •-----------------•---•----__--•-_----•------------•--•--------•------- ----------•-------------------••-•-----------.-•--- ---------------------------•-----•-•----- ---•--------•-------•--•------- -----------•------------ ------------------------------ - ------ ---- --------------- -- ............-----•--..------......I-------------- ------•----------------------------------------------- FINAL INSPECTION BY' -----•--- &� Date-----------------/_'.. �°� - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sauth American Street 300 West Oak Srr*et 124 S"ycamore Strut 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,Callforgia- Z, ES 9 REVISED a-59 ZM 5-6Z ATLAS , ti J