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FOR OFF1 E US X30+ APPLICATION FOR SANITATION PERMITPermit No. .. ..... --- ------------------------- ----- ----------------- --- (Complete in Duplicate) Date Issued r / ------------------------------- -- ------------------- ---------------- --- i 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 LOCATION---- �_- -.f_.__` � -------------•------ i t Owner s Name.: ------ - ---'--- -------------- -----------------------------•---• it Address-------------------------- ------- -�-- --------..�4- ------ ---------'-- Contractor's Name eF -._1 __DAY `� I ICx 3T ... . .. .i s% TAn ..qer.V1Ce-••---....._..------------.... Phone-•....... ..63_�+1. Installation will serve: Residence XX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_ Number of bedrooms -A-_ Number of baths ___4. Lot size ...31 --ACr2........_----------------------- Water Supply: Public system $I Community system ❑ Private ❑ Depth To Water Table -_ ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adoben Hardpan ❑ Previous Application Made: (If yes,date_-------_-----------) No ❑ New Construction: Yes ❑ No ME FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool peirmitted'if public 1wer is available within 200 feet.) Septic Tank: I Distance from nearest well-----------------Distance from foundation-------------------.Material-----------------------------------------------Z. Existing µNo!of compartments------------------------Size----,-$- g-Liquid depth--------------------------Capacity------------------- '... Disposal Field: Distance from nearest well-17one---'Distance from foundation......1QDistance to nearest lot line____61 .... Ek3sting Number of ----------------------'Length of each line-------3pt---------------Width of trench.----24-F....---------------_-- �\ &ADD Type of filter mate rial.Septie_:B]Depth of filter material.-----1.97/---- Total length.................aoI--------........ 41� ,Seepage Pit: Distance to nearest well ___None-------Distance from foundation_.... � d I�.Q---------Distance to nearest lot line-_.._�. ____.__ � Number of pits t $ y �,------_-_---Lining material -------.Size: Diameter-----}- -!r-------------Depth------------2f�___._________-- �!DistanceCesspool: 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----------- -------------------------------------------------------------------------------------------------------------------------------- �" .1 F Remodeling and/or,repairing (descr;be):---------U---F...Z---Z' --- ---R-----------------R.J---A---F-------------Y----T- M-----------------------..---••-----••--••---- ... S P L Y = ---N..G---- 5 ----S--•E-------R--------------------------------------- y' ------------------------------------------------•------------------.........------------------------------------------------------------------------------------------------...------------------------------------ -------------------------------------- w---------------------------------------------------------•---- I hereby certify that l`h'ave prepared this application and that the work will be done.:in accordance with San Joaquin County ordinances, State laws,(aA`&rules and regulations of the n Joaquin Lo al Health District. . i (SignedB__: Thi'---DAY &---NIGHT Sep -- '----a- _- _ _q- ----- C (o ; Contractor) y [Title)--- - - - - -------- --- ---�------- - --------------------------- ------------- - ----- -- -- - - (Plot plan, showing size of lot, location of system in rel n to weIls, buildin S. etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -•---------------------•------------ DATE--- ZZ ��?------------------- REVIEWEDBY----------------------------------------- ._----------------------------------------------------............... DATE------------------------------------------------------------ ---------------------------------- BUILDING PERMIT ISSUED------------------------ DATE----------------------------------- ------------------------- <T.... ions a /or recommendation :---4- -Z_'?_-_ ____.„ _...____]_h_Sec, -------____- - �. - - z 5- -------OR--------Co.o1 --- �-�-�{ _. .. . . .. = ------------------------- -------••--------- --------------------- ----- ---------------- --------------------------------------------- ------------------------ -- --- ---.._ FINALINSPECTION BY:...��...------------------------ -- •--------------- Dafie , .. ---••-------------------------------------------------------- ...-. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 2M 5-62 ATLAS