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--- APPLICATION FOR SANITATION PERMIT Permit No. ---- --------------- __5 (Complete inn Duplicate) - This Permit I:x ires I Year From Date Issued Date Issued .__l'Lf � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with Cour4,VOrdinance No. 549. ..E l JOB ADDRESS AND LOC TION.._'._ `�%�J/ 7 i - -•- --�--- - •O- •_xi-- rfi .: Owner's j Name---•------••--_-•..� -----•----•--•--------••---- r � r= A.�r_. _. Address ------- - -- --- ------- -= - 4_:`- -� Phone_- ` ---------- - ---- -- ---- - -••-------•----- ---- ---------------•-----•------ Contractor's Name. -•-------------- / r { - ---- .----•---••-----• --- Phone-....5;lJ ... Installation will serve; Residence ' Apartment House ❑ Commercial ❑ Trailer Court Number of living units: . Number of bedrooms ___ ❑ Motel ❑f Other I---- - Number of baths .- _._ Lot size __-_.__..__- __ �� Water Supply: Public ystem Community`system ❑� Private ❑ Depth to Water Table _I? ft. F Character of soil to a depth of 3 feet: Sand [) Gravel [] tSandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date---._-__€____.___.) ;NoN"' TYPE Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND 5PECIFICATIONS # j{ A (No septic tank.or cesspool permitted if,publi _sewer is av liable within 200 feet.) ii Se tic Tank: Distance from nearest well_ t om.f ands ion. _ ......... Mat ri 1__.___.__ � ��` 4 No. of compartments__ Dista fr F ;., r� # _= Size-- d ;r - ==Liquid .de th_. - • Capacity l �y P �r - Di posal Field: Distance from near well._R----•--Distance from foundation' �r 4 �f�_ Distance to nearest 1 t lire-_ Number of lines._ '_� � •1 - �--'---••- ..�__......._. P f each line__.___ T �e of filter materia „ •T Length o17- _-.,--- Width of trench__.. .,_-_.- P x f filter material _ '�� ----- -------- Depth o. , ----Total length--=-------[ .. , ---_--------- Seepage Pit: } Distance to near est well_________________ _ __Distance# t"m �~ YP .�!"OG_ from.foundation....................Distance to nearest lot fine._...__.......__ ❑ Num bar of pits ._..___•----------_-Lining material:_:_` ----------Size: Diameter___-._.._ Depth -•••---•--••-----•-- . Cesspool: S P Distance from nearest well--------_� --� + ❑ Size: Diameter-,_-- ^y pep} ce f Rom found t'on-i'------------•---.Lining material---------------------............... �,. . t -----------------Liquid Capacity--------------------- 'k gals. Priv �' -. ❑ Distance to nearest lot line __. - �' E ' " -0's+ante from nearest building Y� 'Distance from nearest well_____ __ _�--- _ �� 9 __ Remodeling and/or repairing (describe):___«___..�� _�s � ,f�. � • , ti ' r Irl! •--•-------- ----- ............----------- _<-ere = ----- -•--------- --- •--------- -------- ------- ... -------------------- --•-••--------•----•- ----------•----- hereby certify }list I have prepared this application and fhat,the work will be done in accordance with San Joaquin County ordinances, State laws,"and rules and regulations of`fhe San Joaquiri Local HealWDisfrict. s�(Signed) - '3 -------------------(Owner and/or Contractor) __ _ By:............................................................_. F -•-----------------------•--------• - -•- - ---------.(Title)--- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed -- o-- reverse side FOR DEPARTMENT USE ONLY [ APPLICATION ACCEPTED BY__--------------------- ` ---•-----------------------•---- ------- 1------------ DATE------- ---- •------- ----------- VIEWED BY ... --• -- ---------- BUILDING PERMIT ISSUED DATE- .._. ---•------- .,_ DATE Alter ions n or re om d' }' ns;- .. ._r,_..._�. •.................... . -; -.-��- a? --•---- ------. ----- --- -- - - tel'-------•--------.:-- ... -------------------------- •-- --...- RNAL INSPECTION BY ........ �_� �� SAN JOAQUIN�OCAL HEALTH DISTRICT 130 South American street 300 West Oak Strd 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California nEV16£O 8-99 YM 4-61 ATLAS Manteca,California Tracy,California i8�Si