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FOROFFICE USE: ---•-- APPLICATION FOR SANITATION PERMIT Permit No. ... ........ ------------------------- ------ ------•--- (Complete in Duplicate) Date Issued ----- l.l....- This Permit Expires 1 Year From Date Issued 68a-0-5 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h rein described. This application is made in compliance with Cou ty Ordinan a No. 549 019 O X 777 s J08 ADDRESS ANWOCON..:. - - ------• U� l. I. Owner's Namea I ------•----- Phona�� .'�... !•-••- i r� - - --- - Address-----'----•------------pIV--•-�f�--�--+.... a - -- ------ -----------•-•--•----------------Pho adz'� . Contractors Name................... -------------------•------..........---------•--....• n --• (P -- Installation will serve: Residence ❑ Apartment House ❑ Commercial8ra41_14*qt ;1110, urt E] Motel El Other ❑ Number of living units: -------- Number of bedrooms -------- Number oasize r Water Supply: Public system [-] Coi mmunity system ❑ private xDepth to Water Table4-_ ft. Character of soil to a depth of 3 feet:i Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: {If yes,date----------- --------) No ❑ New Construction: Yes [�o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if ubliq sewer is available within 200 feet.) �q i Septic Ta k: Distance from nearest well40V--_-.tDistance from foundation_/6-----_-___.Material___ 174>v_.- ......... No. of compartments_.______�---�.------Size.-- ---Liquid depth--------��...--'F----------Capacity.-/Aw -_ '1 Disposal Field: Distance from neatesst ell.,.�____fi_.Distaance from foundation_�./.Q___ _._f.Distance to nearest lot line.......... [� Number of lines_______ _____________ _ Length of each line fz8________/&O....Width of trench______../ .......... . Type of filter material._.�t_.l�tokDepth of filter material....,1.8_��_____.Total length____-_________..__.G- Afs...._.. . Seepage Pit: Distance to nearest well----------------------Distance from foundation_._..._....i_._....Distance to nearest lot line________-__•----_ �1 ❑ Number of pits----------------------Lining material--------•--------------Size: Diameter-------••-------._..._..Depth--------------------------------- h 4 • Cesspool: Distance from nearest well_________________Distance from foundation-------------1------Lining material--------------....................... ❑ Size: Diameter------------------------------------.-Depth------------------------------------------ -------Liquid Capacity--------------------------- Privy: Distance from nearest well ______________----------------------------------Distance from I earest building____-___-______-•___--•-••-.--.--,_--_-._. ---Distance-•to-nearest-lot-line:- Remodeling and/or repairing (describe):-------•------•-----------------------------------------• -•----•-------------�------------- -----•-................................--------- 14 ! 1 1 ................. ................•••--•-•------....--••.................11 .............--•-----------•--------------------------------•-••-----•------------------------ ------- I I I i I I hereby ce NY thaf.I have prepared this application and that the work will be done in accordance with,San Joaquin County ordinances. S to vis',j"6 ru s and-regutations of the San Joaquin Local Health District. \ (Signed)---" Signed] # �7 J��n'er and or Con+rector)f ` ------------ _ tiff `^" — --.------- Title [Plot plan, showing size of lot, location 6f system in relation t sr buildings, etc., can be paced on reverse side]. 1 - FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY---------------j.__i- - -------- -- s --------------------------- �--- _ DATE7-~ REVIEWEDBY------------------------•---..........----------------------------------------------------------------I----------------------(DATE---- -••--------------•--------•- -------•.............. I BUILDINGPERMIT ISSUED..................:--------------------------------•---------- ------------ _. ,DATE------••---------------••-•---••-------•---•-------------...- Alterations and/or recommendations:__;: _ ----••----•------ ------------------------ : --------------------------------------------------------------- -----------------------•---------------------- FINAL INSPEC 7 4 a' 7 Date......---- ------------------ --------------------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t Lodir California Manteca,California Tracy,California EB 9 REVISED B•59 YM 5-61 ATLAS