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FOR SE: v- f- -------- � Il_ �y�_____./l APPLICATION FOR SANITATION PERMIT Permit No. ...1f5.�.. (Complete in Duplicate) /� ----------------------- This Permit Expires 1 Year From Date Issued Date Issued .....___.14 -t-- Application tomApplication is hereby made to the San Joaquin Local Healfh 'District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5 9. A�DRESS AN OCATION-----�!---- -- ' �L,e'�/ - --•------- --------- ------------- -- ------ --------- rU 3 =�l Owner's Name ----- Phone_...-----•-----------••--•- ... ___ __4 ________ _______________________________ _-----------------------___________ _ Address........ - - - • --------- ----•---•- Contractor's Name-------------------------- _a -_"-_' __ t Phone. - --- • - --- ------------------------•-----------•-------------- ---- . J - ---� •-•-�f--•fes Installation will serve: Residence ❑ Apartment House ❑ Comrnercial ❑ Trailer G rt Motel ❑ Other Number of living units: -------- Number of bedrooms __ Number of baths _ _ o Ize a-6"('. Water Supply: Public system ❑ Community system ❑ Private 9 Depth To Water Table!�d_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe &1H"ardpan Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes P--No ❑ -FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicseweris available within 200 feet.) &tL� Septic T Distance from nearest well �__:"____._Distance {fom fandation__f _______.__.Mate�ial____PLO____________ _____________ . --X'-'?- . No. of compartments-------- _ -- -------._Slze�---- --••---•---Liquid depth__.-�----------•- -._Capeclty------------•-----.. Disposal d: Distance from nearest well". .f---Distance from foundatiop.__J_.Q-�.____-Distance to nearest lot line__.T..�_..... Number of lines_______,_ ________Length of each line. 0 g -------y-�'--D�---..Width of trench---•-- �'-=•• - - Type of filter material... .._- a k_Depth of filter material____..kg_ --------Total length------------------�5!"�----•---•,- Seepage Distance to neares ell_I��__ Distanc om foundation_.`_ -_'-____. 7 _ Djffian fio��earest lot line_______.. Number of pits----- ------------- --Lining material_ M4-- .Size: Diameter T_ _41 33 Dept h-------2-�."------•---- I_ 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 ❑ Dlsfiance to nearest lot line_.. ------ ----------------------•-----------------•-----------• -•---------.•------- ---- t I Remodeling and/or repairing (describe): ----------... ---- - -------------- +fir •----------------------------------------•----•---•-------•-----------•----------- --------------------------------•--- ----------• -----•- I hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, Ste w�andrules' nd regula ns of the San Joaquin Local Health District. (Signed)-------- wrier Contractor) -- "" - --. r an r aY� •---------•----•---•-----------•-------•-----"-------------------•---- -- - -------------(Title)- -- w o (Plof plan, showing size of lot, location of system in relation to wells, build! , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY } APPLICATION ACCEPTED BY-----�---T----- Ls - ---------------- REVIEWED BY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED------------_------------ ----- ------------------_----------------- -------------- DATE------------------------------ Alterations and/or recommendations:---1--Z----1-1--_(k_z----------Is--'--� �� +h.. .-------------------------------- - -- -----------� ( - --•-•------....------------------------------------------------------------------------------------------------------------ t __________________________________ j FINAL INSPECTION BY:......---- � � rDate-------------------- ------- - —SAS O UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street r Stockton,California Lodi,California05 Street Manteca,CaliforniaCllflTraccyy,,Californiaf E5 9 REVISED 6-59 2M 5-62 ATLAS � �