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F r R OFFIC US �•�,,.� -� �� Permit No. _, ---------------------------------- APPLICATION FOR SANITATION PERMIT �•.a (Complete in Duplicate) Issued ----------- - -- --- This Permit Expires 1 Year From Date Issued Date .._._: ......... ._ 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...' 573•/8' --- MP?IR-T------------------------------------------------ --------------------------........... f -------------- Phone.�i .. XsS7f'------ Owner s Name.------- 120.y------- Address.--•-------------------------....... ------------------ -------------------------------------------------- ---------------------------------------------------------- ----------- Contractor's Name----- x t o l s `S `f- I/Vc-------------------------------•............. Phone.l-tf__ . fw'�Q.7-- Installation will serve: Residence Ej' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...%Z Num _ _.. Number of bedrooms _ :__ Number of baths . .Lot size ..:fr1r. J�_.__1./..a_'______________________ Water Supply: Public system 2' Community system ❑ Private ❑ Depth TO Water Table SO. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El" Clay ❑ Adobe a'Hardpan ❑ Previous Application Made: {If yes,date--------------------] No ET New Construction: Yes ❑ No Q' FHA/VA: Yes ❑ No Q' k TYPE OF INSTALLATION AND SPECIFICATIONS:, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C L Septic Tanl fl,(, Distance from nearest well./y��✓ Distance from foundation___!._Q___. ..__.Material____....- _- «` -••--- [� CANo. of comparfinents---------- ----------•:size SLiquid eth----- 0P -- -- 3 --�......Capacity._�Fq!5?_,,9 iON- Disposal Field: Distance from nearest weir.... _Distance from foundation_.�S�'.______.Distance to nearest lot line____�_._.... M ® �X15f1,l- Number of lines'--------_--1-------------- Length of each line........9'�o--'__------.-•_Width of trench--------A- ------------------- ADP Type of filter material.. Q9/C---:-----Depth of filter material_._-Ze-----------Total length----...._---90........ -..- Seepage Pit r 06 Distance to nearest well---/1�a K-.__-Distance from foundation---X570.`....__..Distance to nearest lot line-----s�_.- ---- 06 r-'R�pD Number of pits----_Y--------------Lining material__.��._� C-----.Size: Diameter----... 3 -.___-Depth----.R,��___..__.____._.... m nearest well from foundation._....___----_.--.. g Lininmateria!__..__._.__.___________._ Cesspool: Distance from ------------ { ' ❑ -------Liquid Capacity------------------------_-gals. F Size: Diameter--°---------•----- - --------------Depth----------------- --- --------------------- . t tIL - Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ r ❑ Distance to nearest lot line---------------- ------------------------------------------------------ Remodeling and/or repairing (describe) 1:a CQ1pe/ S*r C.....sf ----------•-•--•-------•---' .. --------------- ---------------------------------••--------•-------1-„---- •----- ............ -•-----------------------..-------- ---•---------------------------------------------•-- I 7•---------------------------------------------------------------------- herebif-a- certify that I have prepared this applicafion and that the work will be done in accordance with San Joaquin County i ordinances, te laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----------.9�-a-=-----. . � `----- -------- •-•---••-------- __{Owner end/or Contractor) iTitle s---------------- ---- ------------------ By:--------------A-�-_------... -----------------------•---------------------------------------( (Plot plan. showing size of lot, iocatio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----�--^------ -------------------- ----------- ----------------------------------•--- DATE-- ---------- REVIEWEDBY---------------------------------------------- ---------------------------------------------------••-•-- ------ DATE--------------------•-•-----------------------------•------- BUlLDINGPERMIT ISSUED--------------------------------------------------------- --------------------------•--------------- DATE------------------------------------------------------------- Alterations and/or recom end'ations:_--------- --- - - -----------•---------- I � -----�.��--'.----�-�------� ----•-�--�--LC,_--- - --- �•- ---�=---� �''.�-ate--- ----- - -----•``.. .�------�--1..----------.....-- ------------------------ -------------------------------------------------------------------- -•-- FINAL INSPECTION BY:: .� ._ t %"t •`__--,v---------- Date �� ---=_ �' SAN JOAQUIN LOCAL HEALTH DISTRICT 4 130 South American Street 300 West Oak Street 124 Sycamore Street ..205 West 9Th Street Stockton,California Lodi,California Manteca,California ' ' ` Tracy,California = t ES 9 REVISED 8-59 2M 5-62 ATLAS - -